Provider Demographics
NPI:1912661133
Name:FIRST COAST CARDIOVASCULAR SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:FIRST COAST CARDIOVASCULAR SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YAZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHATIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-493-3333
Mailing Address - Street 1:PO BOX 551308
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32255-1308
Mailing Address - Country:US
Mailing Address - Phone:904-493-3333
Mailing Address - Fax:904-493-2222
Practice Address - Street 1:7011 A C SKINNER PKWY STE 170
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6953
Practice Address - Country:US
Practice Address - Phone:904-493-3333
Practice Address - Fax:904-493-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty