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Organization
2096 EAST OCEAN BOULEVARD, LC
Active
Organization
2096 EAST OCEAN BOULEVARD, LC
Active
Other names
Surgery Center of Stuart
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BARBARA ANN TIDWELL (ADMINISTRATOR)
(772) 223-0174
Entity
Organization
Contact information
Practice address
2096 SE OCEAN BLVD, STUART, FL 34996-3304
(772) 223-0174
(772) 223-0558
Mailing address
2096 SE OCEAN BLVD, STUART, FL 34996-3304
(772) 223-0174
(772) 223-0558
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
901
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0097410006
CIGNA
FL
05
—
079144000
—
FL
01
—
490004057
RAILROAD MEDICARE
FL
01
—
61D
BCBS
FL
Enumeration date
11/20/2006
Last updated
02/02/2012
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