Provider Demographics
NPI:1447209358
Name:WATERS EDGE SURGERY CENTER INC
Entity Type:Organization
Organization Name:WATERS EDGE SURGERY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-286-9000
Mailing Address - Street 1:201 SE OSCEOLA ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2210
Mailing Address - Country:US
Mailing Address - Phone:772-286-9000
Mailing Address - Fax:772-220-4077
Practice Address - Street 1:201 SE OSCEOLA ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2210
Practice Address - Country:US
Practice Address - Phone:772-286-9000
Practice Address - Fax:772-220-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH20803261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH20803OtherFL LICENSE
BW8941850OtherFEDERAL DEA
FLF1270Medicare ID - Type Unspecified