Provider Demographics
NPI:1285609602
Name:OCALA FL ASC LLC
Entity type:Organization
Organization Name:OCALA FL ASC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:2207 SW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-5105
Mailing Address - Country:US
Mailing Address - Phone:352-351-1200
Mailing Address - Fax:352-351-1850
Practice Address - Street 1:2207 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-5105
Practice Address - Country:US
Practice Address - Phone:352-351-1200
Practice Address - Fax:352-351-1850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1141261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0760765-00Medicaid
FL=========344740000OtherPALMETTO GBA-TRICARE SO.
FL0760765-00Medicaid
FLF1370Medicare PIN
FL10C0001370Medicare Oscar/Certification