Provider Demographics
NPI:1780871319
Name:SURGICAL SPECIALISTS ASC, LLC
Entity type:Organization
Organization Name:SURGICAL SPECIALISTS ASC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-315-9206
Mailing Address - Street 1:1034 MAR WALT DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6645
Mailing Address - Country:US
Mailing Address - Phone:850-315-9385
Mailing Address - Fax:850-315-9350
Practice Address - Street 1:1034 MAR WALT DR STE 300
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6645
Practice Address - Country:US
Practice Address - Phone:850-315-9385
Practice Address - Fax:850-315-9350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1515Medicare PIN