Healthcare Provider Details

I. General information

NPI: 1154366060
Provider Name (Legal Business Name): SURGERY CENTER OF NORTH FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6520 NW 9TH BLVD
GAINESVILLE FL
32605-4205
US

IV. Provider business mailing address

6520 NW 9TH BLVD
GAINESVILLE FL
32605-4205
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-7987
  • Fax: 352-331-2787
Mailing address:
  • Phone: 352-331-7987
  • Fax: 352-331-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberASC000252
License Number StateFL

VIII. Authorized Official

Name: DR. ROGER THOMAS BRILL
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 352-331-7987