Provider Demographics
NPI:1336852854
Name:BAPTIST BEACHES SURGERY CENTER LLC
Entity Type:Organization
Organization Name:BAPTIST BEACHES SURGERY CENTER LLC
Other - Org Name:HORIZON SURGERY CENTER BEACHES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA, CST, ACHE
Authorized Official - Phone:787-630-7372
Mailing Address - Street 1:1577 ROBERTS DR STE 120
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3264
Mailing Address - Country:US
Mailing Address - Phone:904-709-4510
Mailing Address - Fax:904-709-4509
Practice Address - Street 1:1577 ROBERTS DR STE 120
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3264
Practice Address - Country:US
Practice Address - Phone:904-709-4510
Practice Address - Fax:904-709-4509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-29
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical