Basic Information
| Provider Information | |||||||||
| NPI: | 1811023906 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HECHTMAN SURGICAL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 OAKFIELD DR | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335115700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136762273 | ||||||||
| FaxNumber: | 8136541384 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 OAKFIELD DR | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335115700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136762273 | ||||||||
| FaxNumber: | 8136541384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 01/05/2016 | ||||||||
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| AuthorizedOfficialLastName: | MAYO | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 8136762273 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 87506 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 003183400 | 05 | FL | MEDICAID |