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Organization

QSS-SOUTHEAST CLINICAL SERVICES LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CAREEN E WILSON (MANAGER)
(973) 894-1263
Entity
Organization

Contact information

Practice address
4215 EDGEWATER DR, ORLANDO, FL 32804-2206
(407) 539-2000
(407) 398-0050
Mailing address
PO BOX 4095, WAYNE, NJ 07470-4095
(973) 826-8080
(866) 309-3354

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
004AH
BLUE CROSS BLUE SHIELD OF FL
FL
05
113496900
FL
01
1740521137
CIGNA
FL
01
3593907
UHC
FL
01
DU0724
RR MEDICARE
FL
Enumeration date
03/08/2013
Last updated
07/07/2023
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