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General NPI Number Information
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NPI Number | 1609931229
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Entity Type | Organization
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Legal Business Name | THE SURGERY CENTER OF JACKSONVILLE LLC
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 10475 CENTURION PKWY N SUITE 101
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City | JACKSONVILLE
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State | FL
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Zip | 32256-5003
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Country | US
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Telephone | 904-652-2328
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Fax |
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Provider Business Mailing Address
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Address Line | 10475 CENTURION PKWY N SUITE 101
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City | JACKSONVILLE
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State | FL
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Zip | 32256-5003
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Country | US
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Telephone | 904-652-2328
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE CLINICAL DIRECTOR
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Name | MS. BEVERLY J TEAGUE
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Credential | RN CNOR LHRM
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Telephone | 904-652-2328
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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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