Healthcare Provider Details

I. General information

NPI: 1003147661
Provider Name (Legal Business Name): SURGICAL TEAM SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S 18TH ST
FERNANDINA BEACH FL
32034-1902
US

IV. Provider business mailing address

1401 RIVERPLACE BLVD #601
JACKSONVILLE FL
32207-9069
US

V. Phone/Fax

Practice location:
  • Phone: 904-421-2119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: LUIS MELENDEZ
Title or Position: OWNER
Credential: CFA
Phone: 904-421-2119