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General NPI Number Information
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NPI Number | 1033113402
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Entity Type | Organization
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Legal Business Name | NORTHWEST FLORIDA SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 4600 N DAVIS HWY
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City | PENSACOLA
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State | FL
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Zip | 32503
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Country | US
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Telephone | 850-494-0048
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Fax | 850-494-0065
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Provider Business Mailing Address
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Address Line | 4600 N DAVIS HWY
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City | PENSACOLA
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State | FL
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Zip | 32503-2337
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Country | US
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Telephone | 850-494-0048
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Fax | 850-494-0065
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/ OFFICER
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Name | DR. GEORGE TIPTON MCKNIGHT
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Credential | MD
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Telephone | 850-494-0048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | ASC0000842
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License Number State | FL
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