Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Ambulatory Surgical |
261QA1903X | 49 | Ambulatory Surgical Center |
| NPI # | 1376881045 |
| LBN Legal business name | 850 PARK SURGICAL |
| Authorized official | DARRICK ANTELL - (MEDICAL DIRECTOR) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 01/30/2013 |
| Last updated | 01/30/2013 - About 13 years ago |
| Identifiers | n/a |
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