| Organization Name: | SURGERY CENTER OF PONTE VEDRA BEACH LLC |
| NPI Number: | 1154741189 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL T DOYLE (CEO) |
| Mailing Address: | 1030 A1a N Ponte Vedra Beach |
| State: | FL US |
| Postal Code: | 320824019 |
| Phone Number: | 9042857202 |
| Fax Number: | 9042853931 |
| NPI Enumeration Date: | 04/17/2014 |
| NPI Last Update Date: | 04/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |