Basic Information
| Provider Information | |||||||||
| NPI: | 1639237092 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MUSCULOSKELETAL AMBULATORY SURGERY CENTER INC | ||||||||
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| OtherOrganizationName: | THE SURGERY CENTER AT POINTE WEST | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8000 SR 64 EAST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417820101 | ||||||||
| FaxNumber: | 9417941863 | ||||||||
| Practice Location | |||||||||
| Address1: | 8000 SR 64 EAST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342123421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417820101 | ||||||||
| FaxNumber: | 9417488587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | SANTINI | ||||||||
| AuthorizedOfficialFirstName: | JODI | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | ASC DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9417820101 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 1093 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 67V | 01 | FL | BCBS FL | OTHER | P00149986 | 01 | FL | RAILROAD MEDICARE | OTHER | 75448000 | 05 | FL | MEDICAID |