Provider Demographics
NPI:1558580910
Name:ORANGE CITY SURGICAL LLC
Entity type:Organization
Organization Name:ORANGE CITY SURGICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-367-2110
Mailing Address - Street 1:1053 MEDICAL CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8261
Mailing Address - Country:US
Mailing Address - Phone:386-878-8080
Mailing Address - Fax:
Practice Address - Street 1:1053 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763
Practice Address - Country:US
Practice Address - Phone:352-000-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical