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General NPI Number Information
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NPI Number | 1730918491
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Entity Type | Organization
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Legal Business Name | NASSAU CROSSING ENDOSCOPY CENTER LLC
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Dates
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Enumeration Date | 07/31/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 462626 STATE ROAD 200 STE 300
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City | YULEE
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State | FL
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Zip | 32097-5494
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Country | US
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Telephone | 469-872-4706
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Fax |
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Provider Business Mailing Address
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Address Line | 462626 STATE ROAD 200 STE 300
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City | YULEE
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State | FL
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Zip | 32097-5494
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Country | US
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Telephone | 904-364-1626
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Fax | 904-207-7959
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Authorized Official
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Title or Position | OFFICER/AUTHORIZED OFFICIAL
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Name | COLLIN LEMAISTRE
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Credential |
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Telephone | 214-213-0732
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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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