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Organization
OAKRIDGE AMBULATORY SURGERY
Active
Organization
OAKRIDGE AMBULATORY SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FRITZ PHANORD (MANAGER BUSINESS OFFICE)
(954) 958-0606
Entity
Organization
Contact information
Practice address
1000 NE 56TH ST, ATTN BUSINESS OFFICE, FORT LAUDERDALE, FL 33334-4149
(954) 958-0606
(354) 776-0821
Mailing address
1000 NE 56TH ST, ATTN BUSINESS OFFICE, FORT LAUDERDALE, FL 33334-4149
(954) 958-0606
(354) 776-0821
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
1081
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214922
AMERIGROUP PROVIDER ID
FL
01
—
278619
AVMED PROVIDER ID
FL
01
—
5461696
AETNA HLTHCR ID
FL
01
—
67P
BC BS PROVIDER ID
FL
01
—
8329702001
CIGNA HLTHCR ID
FL
01
—
836
TOTAL HLTH CHOICE ID
FL
01
—
SG013536
VISTA HLTHCR ID
FL
Enumeration date
01/23/2007
Last updated
08/22/2020
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