1982688628 NPI number — NORTH FLORIDA SURGICAL ASSOCIATES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982688628 NPI number — NORTH FLORIDA SURGICAL ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH FLORIDA SURGICAL ASSOCIATES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982688628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 HEALTH PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-4525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-372-5426
Provider Business Mailing Address Fax Number:
866-831-4898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1121 NW 64TH TER
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32605-4243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-331-3583
Provider Business Practice Location Address Fax Number:
352-331-3669
Provider Enumeration Date:
12/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RODKEY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
MARK
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
850-523-3816

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 275341300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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