Provider Demographics
NPI:1063675734
Name:SURGICAL CENTER AT SUN N LAKE L L C
Entity type:Organization
Organization Name:SURGICAL CENTER AT SUN N LAKE L L C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD OF MANAGERS PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-715-7915
Mailing Address - Street 1:3609 SEBRING PKWY
Mailing Address - Street 2:PMB 30
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-1699
Mailing Address - Country:US
Mailing Address - Phone:863-382-2622
Mailing Address - Fax:863-385-2266
Practice Address - Street 1:4240 SUN N LAKE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-1986
Practice Address - Country:US
Practice Address - Phone:863-382-2622
Practice Address - Fax:863-385-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical