Provider Demographics
NPI:1790752061
Name:NORTH FLORIDA REGIONAL FREESTANDING SURGERY CENTER LP
Entity Type:Organization
Organization Name:NORTH FLORIDA REGIONAL FREESTANDING SURGERY CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:SWINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-789-2877
Mailing Address - Street 1:6705 NW 10TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4212
Mailing Address - Country:US
Mailing Address - Phone:352-333-4555
Mailing Address - Fax:352-333-4556
Practice Address - Street 1:6705 NW 10TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4212
Practice Address - Country:US
Practice Address - Phone:352-333-4555
Practice Address - Fax:352-333-4556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-04
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1008261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103534OtherAVMED HEALTH PLANS
FL079112100Medicaid
FL62ROtherBLUE CROSS BLUE SHIELD
FL079112100Medicaid