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General NPI Number Information
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NPI Number | 1508305038
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Entity Type | Organization
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Legal Business Name | AMELIA ISLAND OUTPATIENT SURGERY CENTER LLC
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Dates
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Enumeration Date | 02/16/2017
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 2416 LYNNDALE RD
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-5201
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Country | US
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Telephone | 561-358-1399
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Fax |
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Provider Business Mailing Address
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Address Line | 2416 LYNNDALE RD
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-5201
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Country | US
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Telephone | 561-358-1399
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | AMOS DARE
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Credential | MD
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Telephone | 561-358-1399
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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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