Healthcare Provider Details

I. General information

NPI: 1801129812
Provider Name (Legal Business Name): RMSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 11/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 MONUMENT RD SUITE 302
JACKSONVILLE FL
32225-7406
US

IV. Provider business mailing address

1205 MONUMENT RD SUITE 302
JACKSONVILLE FL
32225-7406
US

V. Phone/Fax

Practice location:
  • Phone: 904-727-1061
  • Fax:
Mailing address:
  • Phone: 904-727-1061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1318
License Number StateFL

VIII. Authorized Official

Name: MR. ROGER NOLAN PHILLIPS III
Title or Position: MANAGING PARTNER
Credential:
Phone: 770-335-9797