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General NPI Number Information
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NPI Number | 1669483137
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Entity Type | Organization
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Legal Business Name | PHYSICIANS AMBULATORY SURGERY CENTER INC
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 300 CLYDE MORRIS BLVD SUITE B
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5956
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Country | US
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Telephone | 386-672-1080
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Fax | 386-672-8628
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Provider Business Mailing Address
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Address Line | 300 CLYDE MORRIS BLVD SUITE B
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5956
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Country | US
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Telephone | 386-672-1080
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Fax | 386-672-8628
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. ELIZABETH LEE BAYLOR
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Credential |
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Telephone | 386-672-1080
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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 | 886
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License Number State | FL
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