Healthcare Provider Details

I. General information

NPI: 1477500767
Provider Name (Legal Business Name): SOUTHPOINT SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7051 SOUTHPOINT PARKWAY
JACKSONVILLE FL
32206-0911
US

IV. Provider business mailing address

PO BOX 10908
JACKSONVILLE FL
32247-0908
US

V. Phone/Fax

Practice location:
  • Phone: 904-854-4854
  • Fax: 904-398-6408
Mailing address:
  • Phone: 904-854-4854
  • Fax: 904-398-6408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ERNST NICOLITZ
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 904-854-4854