Provider Demographics
NPI:1861071250
Name:ADVENTHEALTH SURGERY CENTER MILLS PARK LLC
Entity type:Organization
Organization Name:ADVENTHEALTH SURGERY CENTER MILLS PARK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMAISTRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-213-0732
Mailing Address - Street 1:1812 N MILLS AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1834
Mailing Address - Country:US
Mailing Address - Phone:407-420-0100
Mailing Address - Fax:407-286-4420
Practice Address - Street 1:1812 N MILLS AVE STE 210
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1834
Practice Address - Country:US
Practice Address - Phone:407-420-0100
Practice Address - Fax:407-420-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-05
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical