Provider Demographics
NPI:1215144191
Name:SURGICAL SPECIALISTS OF OCALA PA
Entity type:Organization
Organization Name:SURGICAL SPECIALISTS OF OCALA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-237-1212
Mailing Address - Street 1:1920 SW 20TH PLACE
Mailing Address - Street 2:BUILDING 100
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7881
Mailing Address - Country:US
Mailing Address - Phone:352-237-1212
Mailing Address - Fax:352-237-0066
Practice Address - Street 1:1920 SW 20TH PLACE
Practice Address - Street 2:BUILDING 100
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7881
Practice Address - Country:US
Practice Address - Phone:352-237-1212
Practice Address - Fax:352-237-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59502208600000X, 2086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251276900Medicaid
FL255529800Medicaid
FLCI7785OtherRAILROAD MEDICARE
FLF69827OtherUPIN
FL251276900Medicaid