| Organization Name: | SURGERY CENTER OF MOUNT DORA, LLC |
| NPI Number: | 1164656740 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JUAN USON (ADMINISTRATOR) |
| Mailing Address: | 3710 Lake Center Dr. Mount Dora |
| State: | FL US |
| Postal Code: | 32757 |
| Phone Number: | 3523831268 |
| Fax Number: | 3523853199 |
| NPI Enumeration Date: | 05/11/2009 |
| NPI Last Update Date: | 12/02/2014 |
| 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: | |