Healthcare Provider Details

I. General information

NPI: 1639360258
Provider Name (Legal Business Name): BEACHES FACIAL AND NASAL SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 13TH AVE S STE 125
JACKSONVILLE BEACH FL
32250-3260
US

IV. Provider business mailing address

1361 13TH AVE S STE 125
JACKSONVILLE BEACH FL
32250-3260
US

V. Phone/Fax

Practice location:
  • Phone: 904-249-2580
  • Fax:
Mailing address:
  • Phone: 904-249-2580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT J TRIMAS
Title or Position: OWNER
Credential: MDFACS
Phone: 904-249-2580