Provider Demographics
NPI:1164491874
Name:OUTPATIENT SURGERY CENTER OF ST AUGUSTINE LLC
Entity Type:Organization
Organization Name:OUTPATIENT SURGERY CENTER OF ST AUGUSTINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:VOLK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-825-0540
Mailing Address - Street 1:ONE ORTHOPAEDIC PLACE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST. AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086
Mailing Address - Country:US
Mailing Address - Phone:904-209-1400
Mailing Address - Fax:904-209-1401
Practice Address - Street 1:ONE ORTHOPAEDIC PLACE
Practice Address - Street 2:SUITE 200
Practice Address - City:ST. AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086
Practice Address - Country:US
Practice Address - Phone:904-209-1400
Practice Address - Fax:904-209-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1244261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1462Medicare PIN