Provider Demographics
NPI:1417054826
Name:SURGICAL ASSOCIATES OF NORTH FLORIDA LLC
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF NORTH FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SADOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-797-6627
Mailing Address - Street 1:P O BOX 3127
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-3127
Mailing Address - Country:US
Mailing Address - Phone:904-797-6627
Mailing Address - Fax:904-797-6028
Practice Address - Street 1:2460 OLD MOULTRIE ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4198
Practice Address - Country:US
Practice Address - Phone:904-797-6627
Practice Address - Fax:904-797-6028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54115208600000X
FLME87867208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269607000Medicaid
FL062191900Medicaid
FL062191900Medicaid
FL269607000Medicaid
FLE66207Medicare UPIN
FL81364Medicare ID - Type UnspecifiedMEDICARE NUMBER