Basic Information
| Provider Information | |||||||||
| NPI: | 1477500767 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTHPOINT SURGERY CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10908 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322470908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048544854 | ||||||||
| FaxNumber: | 9043986408 | ||||||||
| Practice Location | |||||||||
| Address1: | 7051 SOUTHPOINT PARKWAY | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322060911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048544854 | ||||||||
| FaxNumber: | 9043986408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NICOLITZ | ||||||||
| AuthorizedOfficialFirstName: | ERNST | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9048544854 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.