Provider Demographics
NPI:1285788505
Name:OAKRIDGE AMBULATORY SURGERY
Entity type:Organization
Organization Name:OAKRIDGE AMBULATORY SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER BUSINESS OFFICE
Authorized Official - Prefix:MR
Authorized Official - First Name:FRITZ
Authorized Official - Middle Name:
Authorized Official - Last Name:PHANORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-958-0606
Mailing Address - Street 1:1000 NE 56TH ST
Mailing Address - Street 2:ATTN BUSINESS OFFICE
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4149
Mailing Address - Country:US
Mailing Address - Phone:954-958-0606
Mailing Address - Fax:354-776-0821
Practice Address - Street 1:1000 NE 56TH ST
Practice Address - Street 2:ATTN BUSINESS OFFICE
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-4149
Practice Address - Country:US
Practice Address - Phone:954-958-0606
Practice Address - Fax:354-776-0821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1081261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8329702001OtherCIGNA HLTHCR ID
FL836OtherTOTAL HLTH CHOICE ID
FL214922OtherAMERIGROUP PROVIDER ID
FL67POtherBC BS PROVIDER ID
FL5461696OtherAETNA HLTHCR ID
FL278619OtherAVMED PROVIDER ID
FLSG013536OtherVISTA HLTHCR ID
FLSG013536OtherVISTA HLTHCR ID
FL=========OtherHUMANA HLTHCR ID
FL8329702001OtherCIGNA HLTHCR ID