Provider Demographics
NPI:1194912337
Name:ORANGE AVENUE SURGICAL SUITE, LLC
Entity type:Organization
Organization Name:ORANGE AVENUE SURGICAL SUITE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:HAYNES
Authorized Official - Last Name:POPE
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:407-857-6261
Mailing Address - Street 1:3872 OAKWATER CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6263
Mailing Address - Country:US
Mailing Address - Phone:407-857-6261
Mailing Address - Fax:407-857-6241
Practice Address - Street 1:3872 OAKWATER CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6263
Practice Address - Country:US
Practice Address - Phone:407-857-6261
Practice Address - Fax:407-857-6241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOSR #567261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical