Healthcare Provider Details

I. General information

NPI: 1902853195
Provider Name (Legal Business Name): NEW SMYRNA BEACH AMBULATORY CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 PALMETTO ST
NEW SMYRNA BEACH FL
32168-7327
US

IV. Provider business mailing address

612 PALMETTO ST
NEW SMYRNA BEACH FL
32168-7327
US

V. Phone/Fax

Practice location:
  • Phone: 386-423-5500
  • Fax:
Mailing address:
  • Phone: 386-423-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1017
License Number StateFL

VIII. Authorized Official

Name: DR. MARK NAGRANI
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 386-423-5500