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General NPI Number Information
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NPI Number | 1922085059
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Entity Type | Organization
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Legal Business Name | ASC NORTH LLP
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 590 DUNDAS DR
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City | JACKSONVILLE
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State | FL
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Zip | 32218-5579
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Country | US
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Telephone | 904-276-9311
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Fax | 904-276-4462
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Provider Business Mailing Address
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Address Line | PO BOX 2290
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City | ORANGE PARK
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State | FL
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Zip | 32067-2290
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Country | US
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Telephone | 904-276-9311
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Fax | 904-276-4462
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Authorized Official
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Title or Position | CFO
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Name | LYNN BRYANT
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Credential |
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Telephone | 904-276-9311
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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 | 998
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License Number State | FL
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