Provider Demographics
NPI:1033113402
Name:NORTHWEST FLORIDA SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:NORTHWEST FLORIDA SURGICAL CENTER, LLC
Other - Org Name:NORTH FLORIDA SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR/ OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:TIPTON
Authorized Official - Last Name:MCKNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-494-0048
Mailing Address - Street 1:4600 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2337
Mailing Address - Country:US
Mailing Address - Phone:850-494-0048
Mailing Address - Fax:850-494-0065
Practice Address - Street 1:4600 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503
Practice Address - Country:US
Practice Address - Phone:850-494-0048
Practice Address - Fax:850-494-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLASC0000842261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLASC0000842OtherSTATE LISCENCE NUMBER
FLF1193Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER