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General NPI Number Information
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NPI Number | 1497723720
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE BEACH SURGERY CENTER, LLC
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Dates
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Enumeration Date | 03/11/2006
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 3316 SOUTH THIRD STREET STE 200
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250
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Country | US
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Telephone | 904-247-8181
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Fax | 904-247-8101
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Provider Business Mailing Address
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Address Line | 3316 SOUTH THIRD STREET STE 200
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250
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Country | US
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Telephone | 904-247-8181
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Fax | 904-247-8101
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Authorized Official
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Title or Position | OFFICER AND AUTHORIZED OFFICIAL
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Name | JENNIFER B. BALDOCK
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Credential |
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Telephone | 615-234-5954
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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 | 1120
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License Number State | FL
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