Provider Demographics
NPI:1578662227
Name:PACE SURGERY CENTER
Entity type:Organization
Organization Name:PACE SURGERY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:STOVALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-416-7681
Mailing Address - Street 1:3754 HIGHWAY 90
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-1096
Mailing Address - Country:US
Mailing Address - Phone:850-994-1883
Mailing Address - Fax:
Practice Address - Street 1:3754 HIGHWAY 90
Practice Address - Street 2:SUITE 120
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-1096
Practice Address - Country:US
Practice Address - Phone:850-994-1883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SACRED HEART HEALTH SYSTEM, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-21
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1482OtherMEDICARE PROVIDER NUMBER
FL076659300Medicaid