| Surgical Practice Resource Group Of Florida Inc | |
|
539 Rolling Acres Rd Lady Lake FL 32159 | |
| (352) 775-6348 | |
| Not Available |
| Full Name | Surgical Practice Resource Group Of Florida Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 539 Rolling Acres Rd, Lady Lake, Florida |
| Authorized Official Name and Position | Steve Roth (COO) |
| Authorized Official Contact | 3527756348 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Surgical Practice Resource Group Of Florida Inc Po Box 489 Lady Lake FL 32158-0489 Ph: (352) 775-6348 | Surgical Practice Resource Group Of Florida Inc 539 Rolling Acres Rd Lady Lake FL 32159 Ph: (352) 775-6348 |
| NPI Number | 1992162291 |
|---|---|
| Provider Enumeration Date | 01/19/2016 |
| Last Update Date | 08/03/2017 |
| Medicare PECOS PAC ID | 5496030819 |
|---|---|
| Medicare Enrollment ID | O20170328001087 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992162291 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | (Florida) | Secondary |
| Provider Name | Claudia Lynn Thomas |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1538194345 PECOS PAC ID: 7810981297 Enrollment ID: I20040408001522 |
| Provider Name | Jeffrey Mandume Kerina |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1447369376 PECOS PAC ID: 9234123613 Enrollment ID: I20100223000759 |
| Provider Name | Myriam Vicioso |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1124240007 PECOS PAC ID: 3971638628 Enrollment ID: I20100819000306 |
| Provider Name | Matthew C Meyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396267753 PECOS PAC ID: 4183981822 Enrollment ID: I20171205000850 |
| Provider Name | Thomas Hatton Mccoy |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1255313730 PECOS PAC ID: 8426092032 Enrollment ID: I20201019002176 |
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