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General NPI Number Information
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NPI Number | 1215990627
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Entity Type | Organization
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Legal Business Name | WESTSIDE SURGERY CENTER LLC
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 2731 PARK ST
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City | JACKSONVILLE
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State | FL
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Zip | 32205-7607
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Country | US
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Telephone | 904-389-1077
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Fax | 904-338-9016
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Provider Business Mailing Address
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Address Line | 2731 PARK ST
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City | JACKSONVILLE
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State | FL
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Zip | 32205-7607
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Country | US
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Telephone | 904-389-1077
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Fax | 904-338-9016
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Authorized Official
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Title or Position | VP
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Name | WILLIAM GREGORY SWINNEY
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Credential |
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Telephone | 972-789-2877
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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 | AHCA895
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License Number State | FL
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