Provider Demographics
NPI:1891184826
Name:SURGICAL CENTER OF NORTH FLORIDA, LLC
Entity Type:Organization
Organization Name:SURGICAL CENTER OF NORTH FLORIDA, LLC
Other - Org Name:SURGICAL CENTER OF NORTH FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REVENUE MANAGEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEALS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-285-7500
Mailing Address - Street 1:6520 NW 9TH BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4205
Mailing Address - Country:US
Mailing Address - Phone:352-224-7800
Mailing Address - Fax:352-331-2787
Practice Address - Street 1:6520 NW 9TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4205
Practice Address - Country:US
Practice Address - Phone:352-224-7800
Practice Address - Fax:352-331-2787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL922261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical