Basic Information
| Provider Information | |||||||||
| NPI: | 1588669204 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURGERY CENTER OF CORAL GABLES, LLC | ||||||||
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| OtherOrganizationName: | CORAL GABLES SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2645 DOUGLAS ROAD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331332744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054613229 | ||||||||
| FaxNumber: | 3054613288 | ||||||||
| Practice Location | |||||||||
| Address1: | 2645 DOUGLAS ROAD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331332744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054613229 | ||||||||
| FaxNumber: | 3054613288 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2005 | ||||||||
| LastUpdateDate: | 03/06/2008 | ||||||||
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| AuthorizedOfficialLastName: | SEYMOUR | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3054613229 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CASC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 1163 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.