Healthcare Provider Details

I. General information

NPI: 1407873292
Provider Name (Legal Business Name): SURGERY CENTER OF VOLUSIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 S CLYDE MORRIS BLVD SUITE 500
PORT ORANGE FL
32129-2300
US

IV. Provider business mailing address

1A BURTON HILLS BLVD # L&C
NASHVILLE TN
37215-6187
US

V. Phone/Fax

Practice location:
  • Phone: 386-760-8151
  • Fax: 386-760-8185
Mailing address:
  • Phone: 615-240-3820
  • Fax: 615-234-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1175
License Number StateFL

VIII. Authorized Official

Name: MR. JEFFREY SNODGRASS
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1283