HQM of Surrey Place, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1540096 Issued in FL

Legal business name

HQM OF SURREY PLACE, LLC

Practice address

110 Lee Ave SE
Live Oak, FL 32064-9504

Phone

(386) 364-5961

NPI assigned

Jan 12, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Paul Walczak

Title

Ceo

Phone

(561) 627-0664

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Surrey Place Care Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235433600000",
    "number": "1366421836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 LEE AVE SE",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320649504",
            "telephone_number": "386-364-5961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 LEE AVE SE",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320649504",
            "telephone_number": "386-364-5961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HQM OF SURREY PLACE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-12",
        "last_updated": "2009-02-24",
        "status": "A",
        "authorized_official_last_name": "WALCZAK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-627-0664",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1540096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025710900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Surrey Place Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Steven P. Holliman, M.D.
• Hope Springs ABA LLC
• Horizon Pediatrics, LLC
• Donna J Hoss-Green, FNP
• Trudie Howard
• Audrey Corbett Hughes
• Patricia Darlene Hulsberg
• Integrated Regional Laboratories Pathology Services, LLC
• Kathy Jackson, PT
• James Janousek, M.D.

• Skilled Nursing Facility in Live Oak, FL
• Providers in Live Oak, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.