Provider Demographics
NPI:1386925360
Name:SOUTHGATE ADMINISTRATIVE SERVICES LLC
Entity type:Organization
Organization Name:SOUTHGATE ADMINISTRATIVE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:561-306-0376
Mailing Address - Street 1:6428 DORSAY CT
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6305
Mailing Address - Country:US
Mailing Address - Phone:954-450-8500
Mailing Address - Fax:
Practice Address - Street 1:2004 N FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-3500
Practice Address - Country:US
Practice Address - Phone:954-450-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No291U00000XLaboratoriesClinical Medical Laboratory