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General NPI Number Information
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NPI Number | 1417903899
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Entity Type | Organization
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Legal Business Name | JUPITER OUTPATIENT SURGERY CENTER LLC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 2055 MILITARY TRL SUITE 100
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City | JUPITER
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State | FL
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Zip | 33458-7801
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Country | US
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Telephone | 561-741-1705
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Fax | 561-741-1397
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Provider Business Mailing Address
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Address Line | 2055 MILITARY TRL SUITE 100
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City | JUPITER
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State | FL
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Zip | 33458-7801
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Country | US
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Telephone | 561-741-1705
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Fax | 561-741-1397
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Authorized Official
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Title or Position | MANAGER
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Name | MS. DONNA M. SCROGGINS
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Credential |
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Telephone | 561-630-6277
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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 | 1132
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License Number State | FL
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