PORT ORANGE ENDOSCOPY & SURGERY CENTER LLC NPI 1619979580

NPI Details

PORT ORANGE ENDOSCOPY & SURGERY CENTER LLC is an ambulatory surgical clinic center in Port Orange, FL. PORT ORANGE ENDOSCOPY & SURGERY CENTER LLC NPI is 1619979580. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

1185 DUNLAWTON AVE STE 100
PORT ORANGE, FL
ZIP 32127-906
Phone: (386) 777-7151
Fax: (386) 231-6545

The provider's authorized official is Cory Domayer .
The authorized official title is Cfo and has the following contact phone number (386) 843-3420.

The CLIA number assigned to this NPI record is 10D2103376 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

• Colorectal cancer screening; colonoscopy on individual at high risk (HCPCS:G0105)
• Diagnostic exam of large bowel using a flexible endoscope (HCPCS:45378)
• Destruction of polyp or growth of large bowel using a flexible endoscope (HCPCS:45388)
• Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery (HCPCS:45384)
• Removal of polyps or growths of large bowel using an endoscope with mechanical snare (HCPCS:45385)
• Biopsy of large bowel using a flexible endoscope (HCPCS:45380)
• Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk (HCPCS:G0121)

The enumeration date for this NPI number is 8/11/2005 and was last updated on 5/5/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available: