Provider Demographics
NPI:1982637492
Name:TOMOKA SURGERY CENTER, LLC
Entity type:Organization
Organization Name:TOMOKA SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:BEDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-672-7575
Mailing Address - Street 1:345 CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3111
Mailing Address - Country:US
Mailing Address - Phone:386-672-7575
Mailing Address - Fax:386-677-2770
Practice Address - Street 1:345 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-3111
Practice Address - Country:US
Practice Address - Phone:386-672-7575
Practice Address - Fax:386-677-2770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1251261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH25641Medicare UPIN
FLD68989Medicare UPIN
FLD21042Medicare UPIN
FLG36263Medicare UPIN