| Organization Name: | ISLAND SURGERY CENTER, INC. |
| NPI Number: | 1366620114 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIANE GWYN BOWEN (PRESIDENT) |
| Mailing Address: | 1015 Arthur J Moore Dr St Simons Island |
| State: | GA US |
| Postal Code: | 315222206 |
| Phone Number: | 9126341993 |
| Fax Number: | 9126341166 |
| NPI Enumeration Date: | 02/04/2008 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | ========= |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |