Healthcare Provider Details

I. General information

NPI: 1558803106
Provider Name (Legal Business Name): OUTPATIENT SERVICE PROVIDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9726 TOUCHTON RD
JACKSONVILLE FL
32246-8304
US

IV. Provider business mailing address

3624 BRIDGEWOOD DR
JACKSONVILLE FL
32277-8903
US

V. Phone/Fax

Practice location:
  • Phone: 904-349-8679
  • Fax:
Mailing address:
  • Phone: 904-349-8679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FADY A EL-BAHRI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 904-739-0050