| Organization Name: | PONTE VEDRA BCH SURGERY CLINIC |
| NPI Number: | 1225050974 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN B HARRIS (OWNER MEDICAL DIRECTOR) |
| Mailing Address: | 1030 A1a N Ponte Vedra Beach |
| State: | FL US |
| Postal Code: | 320824019 |
| Phone Number: | 9042857202 |
| Fax Number: | 9042853931 |
| NPI Enumeration Date: | 07/24/2006 |
| NPI Last Update Date: | 10/20/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 1215 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |