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2096 EAST OCEAN BOULEVARD LC NPI 1609940899


NPI Information

NPI: 1609940899
Provider Name: 2096 EAST OCEAN BOULEVARD, LC

Doing Business As: SURGERY CENTER OF STUART

Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

Address:
2096 SE OCEAN BLVD
STUART, FL
ZIP 34996
Phone: (772) 223-0174
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2096 EAST OCEAN BOULEVARD, LC is an ambulatory surgical clinic center in Stuart, FL. 2096 EAST OCEAN BOULEVARD, LC NPI is 1609940899. The provider is registered as an organization entity type.
The provider Is Doing Business As Surgery Center Of Stuart.

The provider's business location address is:

2096 SE OCEAN BLVD
STUART, FL
ZIP 34996-304
Phone: (772) 223-0174
Fax: (772) 223-0558

The provider's authorized official is Barbara Ann Tidwell .
The authorized official title is Administrator and has the following contact phone number (772) 223-0174.

The enumeration date for this NPI number is 11/20/2006 and was last updated on 2/2/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QA1903XClinic/CenterAmbulatory Surgical901FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1F1046MEDICARE UPINFLORIDA
2490004057OTHERFLORIDARAILROAD MEDICARE
361DOTHERFLORIDABCBS
40097410006OTHERFLORIDACIGNA
5079144000MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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