Organization
VERO BEACH SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAROLE MARY HUSSAMY (ADMINISTRATOR)
(772) 778-0600
Entity
Organization
Contact information
Practice address
845 37TH PL, VERO BEACH, FL 32960-6564
(772) 778-0600
(772) 778-4005
Mailing address
PO BOX 643408, VERO BEACH, FL 32964-3408
(772) 778-0600
(772) 778-4005
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
1121
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
490005126
RAILROAD MEDICARE
FL
01
—
69L
BLUE CROSS BLUE SHIELD OF FLORIDA
FL
Enumeration date
05/16/2006
Last updated
11/09/2011
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