| Organization Name: | MELBOURNE SURGERY CENTER, LLC |
| NPI Number: | 1013309459 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PETER J CLEMENS (VP) |
| Mailing Address: | 95 Bulldog Blvd Suite 104 Melbourne |
| State: | FL US |
| Postal Code: | 329013332 |
| Phone Number: | 3219529800 |
| Fax Number: | |
| NPI Enumeration Date: | 02/23/2015 |
| NPI Last Update Date: | 02/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |