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General NPI Number Information
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NPI Number | 1548224041
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Entity Type | Organization
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Legal Business Name | ST. AUGUSTINE SURGERY CENTER
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 180 SOUTHPARK BLVD
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-4120
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Country | US
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Telephone | 904-823-1447
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Fax | 904-823-9928
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Provider Business Mailing Address
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Address Line | 180 SOUTHPARK BLVD
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-4120
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Country | US
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Telephone | 904-823-1447
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Fax | 904-823-9928
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | ANN GEIER
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Credential | RN
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Telephone | 843-303-0008
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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 | 1057
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License Number State | FL
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