Provider Demographics
NPI:1821342858
Name:SURGCENTER OF ORANGE PARK, LLC
Entity Type:Organization
Organization Name:SURGCENTER OF ORANGE PARK, LLC
Other - Org Name:ORANGE PARK ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMAISTRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-213-0723
Mailing Address - Street 1:805 WELLS RD FL 1
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2301
Mailing Address - Country:US
Mailing Address - Phone:904-643-3326
Mailing Address - Fax:
Practice Address - Street 1:805 WELLS RD FL 1
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2301
Practice Address - Country:US
Practice Address - Phone:904-643-3326
Practice Address - Fax:904-592-9726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical