Provider Demographics
NPI:1467582437
Name:NORTH FLORIDA SURGERY CENTER INC
Entity Type:Organization
Organization Name:NORTH FLORIDA SURGERY CENTER INC
Other - Org Name:NORTH FLORIDA SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAISAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-758-8937
Mailing Address - Street 1:256 SW PROFESSIONAL GLN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-1104
Mailing Address - Country:US
Mailing Address - Phone:386-758-8937
Mailing Address - Fax:386-755-2169
Practice Address - Street 1:256 SW PROFESSIONAL GLN
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-1104
Practice Address - Country:US
Practice Address - Phone:386-758-8937
Practice Address - Fax:386-755-2169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL957261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL490003028OtherRAILROAD MEDICARE
FL079210100Medicaid
FL65SOtherBLUE CROSS BLUE SHIELD
FL235726OtherAVMED
FLF1262Medicare ID - Type Unspecified