Provider Demographics
NPI:1437347416
Name:BRASA SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:BRASA SURGERY CENTER, LLC
Other - Org Name:PRIOR NAME: JOURNEY LITE OF NORTH FLORIDA, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:GOVERNING BODY CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CYWES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-399-4004
Mailing Address - Street 1:8767 PERIMETER PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216
Mailing Address - Country:US
Mailing Address - Phone:904-652-0700
Mailing Address - Fax:904-652-0704
Practice Address - Street 1:8767 PERIMETER PARK BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-652-0700
Practice Address - Fax:904-652-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical