Basic Information
| Provider Information | |||||||||
| NPI: | 1174566715 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTHPOINT SURGERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7051 SOUTHPOINT PARKWAY | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048544854 | ||||||||
| FaxNumber: | 9043986408 | ||||||||
| Practice Location | |||||||||
| Address1: | 7051 SOUTHPOINT PARKWAY | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322160000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048544854 | ||||||||
| FaxNumber: | 9043986408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NICOLITZ | ||||||||
| AuthorizedOfficialFirstName: | ERNST | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9048544854 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.