Provider Demographics
NPI:1952017832
Name:BAPTIST SOUTH SURGERY CENTER, LLC
Entity type:Organization
Organization Name:BAPTIST SOUTH SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP, CLIN SVC LN & AMB BUS DEV
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-202-2230
Mailing Address - Street 1:14540 OLD ST. AUGUSTINE ROAD
Mailing Address - Street 2:MEDICAL OFFICE BLDG. 2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-7418
Mailing Address - Country:US
Mailing Address - Phone:904-648-0100
Mailing Address - Fax:904-618-2159
Practice Address - Street 1:14540 OLD ST. AUGUSTINE ROAD
Practice Address - Street 2:MEDICAL OFFICE BLDG. 2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-7418
Practice Address - Country:US
Practice Address - Phone:904-648-0100
Practice Address - Fax:904-618-2159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical