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General NPI Number Information
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NPI Number | 1437347416
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Entity Type | Organization
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Legal Business Name | BRASA SURGERY CENTER, LLC
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 06/21/2010
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Provider Practice Location Address
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Address Line | 8767 PERIMETER PARK BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32216
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Country | US
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Telephone | 904-652-0700
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Fax | 904-652-0704
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Provider Business Mailing Address
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Address Line | 8767 PERIMETER PARK BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32216
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Country | US
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Telephone | 904-652-0700
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Fax | 904-652-0704
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Authorized Official
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Title or Position | GOVERNING BODY CHAIR
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Name | ROBERT CYWES
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Credential | MD
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Telephone | 904-399-4004
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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 |
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License Number State |
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