Provider Demographics
NPI:1215924899
Name:ATLANTIC SURGICAL CENTER, INC.
Entity type:Organization
Organization Name:ATLANTIC SURGICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BEEBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-946-3603
Mailing Address - Street 1:150 SW 12TH AVE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3298
Mailing Address - Country:US
Mailing Address - Phone:954-946-3603
Mailing Address - Fax:954-781-2144
Practice Address - Street 1:150 SW 12TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3298
Practice Address - Country:US
Practice Address - Phone:954-946-3603
Practice Address - Fax:954-781-2144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1015261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0705969-00Medicaid
FL169570900OtherUS DEPT OF LABOR
FL64XOtherBLUE CROSS BLUE SHIELD
FL0705969-00Medicaid