Healthcare Provider Details

I. General information

NPI: 1164491874
Provider Name (Legal Business Name): OUTPATIENT SURGERY CENTER OF ST AUGUSTINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE ORTHOPAEDIC PLACE SUITE 200
ST. AUGUSTINE FL
32086
US

IV. Provider business mailing address

ONE ORTHOPAEDIC PLACE SUITE 200
ST. AUGUSTINE FL
32086
US

V. Phone/Fax

Practice location:
  • Phone: 904-209-1400
  • Fax: 904-209-1401
Mailing address:
  • Phone: 904-209-1400
  • Fax: 904-209-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1244
License Number StateFL

VIII. Authorized Official

Name: DR. ALBERT G. VOLK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 904-825-0540