Basic Information
| Provider Information | |||||||||
| NPI: | 1053985721 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ENDO SURGICAL CENTER OF KISSIMMEE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 737 W OAK ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347414936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073847388 | ||||||||
| FaxNumber: | 4073847391 | ||||||||
| Practice Location | |||||||||
| Address1: | 737 W OAK ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347414936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073847388 | ||||||||
| FaxNumber: | 4073847391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2021 | ||||||||
| LastUpdateDate: | 05/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | SEELA | ||||||||
| AuthorizedOfficialFirstName: | SRINIVAS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4073847388 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 05/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.