Provider Demographics
NPI:1306087135
Name:CRANE CREEK SURGICAL PARTNERS, LLC
Entity type:Organization
Organization Name:CRANE CREEK SURGICAL PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-541-1776
Mailing Address - Street 1:2222 SOUTH HARBOR CITY BLVD
Mailing Address - Street 2:SUITE 540
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901
Mailing Address - Country:US
Mailing Address - Phone:321-541-1776
Mailing Address - Fax:321-541-1779
Practice Address - Street 1:2222 SOUTH HARBOR CITY BLVD
Practice Address - Street 2:SUITE 540
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-541-1776
Practice Address - Fax:321-541-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10C0001548Medicare Oscar/Certification