Provider Demographics
NPI:1194987222
Name:ADVANCED SURGERY CENTER OF PALM BEACH COUNTY, LLC
Entity type:Organization
Organization Name:ADVANCED SURGERY CENTER OF PALM BEACH COUNTY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-273-2340
Mailing Address - Street 1:5065 STATE ROAD 7
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33449-4615
Mailing Address - Country:US
Mailing Address - Phone:561-273-2340
Mailing Address - Fax:561-237-2331
Practice Address - Street 1:5065 SOUTH STATE RD 7
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33449
Practice Address - Country:US
Practice Address - Phone:561-662-9942
Practice Address - Fax:561-792-5528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical