Healthcare Provider Details

I. General information

NPI: 1447209358
Provider Name (Legal Business Name): WATERS EDGE SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SE OSCEOLA ST
STUART FL
34994-2210
US

IV. Provider business mailing address

201 SE OSCEOLA ST
STUART FL
34994-2210
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-9000
  • Fax: 772-220-4077
Mailing address:
  • Phone: 772-286-9000
  • Fax: 772-220-4077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberPH20803
License Number StateFL

VIII. Authorized Official

Name: ROBERT NATHAN COOPER
Title or Position: PRESIDENT/MEDICAL DIRECTOR
Credential: M.D.
Phone: 772-286-9000