Provider Profile

INTRACOASTAL SURGERY CENTER

Ambulatory Surgical Center

FACILITY PROFILE

Accredited by: Joint Commission
Street Address
  • 2200 W EAU GALLIE BLVD, STE 100
    MELBOURNE, FL 32935
    County: Brevard
  • Phone: (321) 610-3460
Mailing Address
  • 2200 W EAU GALLIE BLVD, STE 100
    MELBOURNE, FL 32935
    County: Brevard
  • Phone: (321) 795-6095
AHCA Reports
Inspection Reports
Inspection Details
Consumer Guides
A Patient's Guide to a Hospital Stay
Patient Safety
Health Care Advance Directives
Facility Information:
Facility/Provider Type:Ambulatory Surgical Center
Administrator:JOHN WHEELER
Financial Officer:BETH EDWARDS
Owner/Licensee:INTRACOASTAL SURGERY CENTER LLC
Owner/Licensee Since:1/7/2019

NamePositionOwnership
SURGICAL CENTER DEVELOPMENT #4 LLC57%
THE KYLE MOYLES IRREVOCABLE TRUST7%
BETH EDWARDSBOARD MEMBER/OFFICER0%
COLLIN LEMAISTREBOARD MEMBER/OFFICER0%
Profit Status:For-Profit
Management Company:USP ORLANDO INC
Manager Since:12/29/2021

NamePositionOwnership
USP DOMESTIC HOLDINGS, INC100%
JAMES BOWDENBOARD MEMBER/OFFICER0%
Licensed Beds:Not Available
Bed Types:Operating Rooms: 2
Recovery Beds: 5
AHCA Number (File Number):14960942
AHCA Field Office:07
License Number:1425
Current License Effective:12/30/2023
Current License Expires:12/29/2025
License Status:LICENSED
Services/Characteristics

Not Available

Legal Actions
Please note the legal actions above may have been issued to a prior owner. The Final Order displays the name of the licensee responsible for the legal action that was taken.
Date Initiated Case # Case Type Violation Fine Amount Date Imposed
Change of ownership occurred 12/30/2021

Important information and facility/provider definitions can be found in the Glossary.

Attn Providers: Requests for changes in data must be sent in writing to the AHCA licensing office.