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General NPI Number Information
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NPI Number | 1417054826
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Entity Type | Organization
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Legal Business Name | SURGICAL ASSOCIATES OF NORTH FLORIDA LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2460 OLD MOULTRIE ROAD SUITE 2
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-4198
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Country | US
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Telephone | 904-797-6627
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Fax | 904-797-6028
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Provider Business Mailing Address
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Address Line | P O BOX 3127
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City | ST AUGUSTINE
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State | FL
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Zip | 32085-3127
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Country | US
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Telephone | 904-797-6627
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Fax | 904-797-6028
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Authorized Official
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Title or Position | DIRECTOR
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Name | GEORGE EDWARD SADOWSKI
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Credential | MD
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Telephone | 904-797-6627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME87867
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME54115
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License Number State | FL
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