| NPI | 1801869847 |
|---|---|
| Doing Business As | INTERCOASTAL MEDICAL GROUP AMBULATORY SURGERY CENTER |
| Entity Type | Organization |
| Authorized Contact | GEOFFREY G SIMON CEO/Administrator 941-955-1108 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: FL 1181) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2016-08-17 |