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Organization
KISSIMMEE ENDOSCOPY CENTER ASSOCIATES, INC
Active
Organization
KISSIMMEE ENDOSCOPY CENTER ASSOCIATES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHAMUS M HOLT MBA (ADMINISTRATOR)
(407) 463-0672
Entity
Organization
Contact information
Practice address
715 OAK COMMONS BLVD, KISSIMMEE, FL 34741-4213
(407) 463-0672
(407) 581-2777
Mailing address
715 OAK COMMONS BLVD, KISSIMMEE, FL 34741-4213
(407) 463-0672
(407) 581-2777
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
1130
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1130
AHCA ASC LICENSE #
FL
Enumeration date
10/06/2006
Last updated
08/22/2020
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