Provider Demographics
NPI:1952771602
Name:ANDREWS SURGERY CENTER AT JACKSONVILLE MEDPLEX LLC
Entity Type:Organization
Organization Name:ANDREWS SURGERY CENTER AT JACKSONVILLE MEDPLEX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JEFF
Authorized Official - Last Name:SAPP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:407-342-5842
Mailing Address - Street 1:3241 HIDDEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5427
Mailing Address - Country:US
Mailing Address - Phone:407-342-5842
Mailing Address - Fax:
Practice Address - Street 1:9726 TOUCHTON ROAD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-8227
Practice Address - Country:US
Practice Address - Phone:407-342-5842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical