Provider Demographics
NPI:1417903899
Name:JUPITER OUTPATIENT SURGERY CENTER LLC
Entity Type:Organization
Organization Name:JUPITER OUTPATIENT SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCROGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-630-6277
Mailing Address - Street 1:2055 MILITARY TRL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7801
Mailing Address - Country:US
Mailing Address - Phone:561-741-1705
Mailing Address - Fax:561-741-1397
Practice Address - Street 1:2055 MILITARY TRL
Practice Address - Street 2:SUITE 100
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7801
Practice Address - Country:US
Practice Address - Phone:561-741-1705
Practice Address - Fax:561-741-1397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1132261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1360Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER