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Organization
PALM COAST SURGERY CENTER LLC
Active
Organization
PALM COAST SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN M. RUSSELL M.D. (PRESIDENT)
(386) 447-4440
Entity
Organization
Contact information
Practice address
21 HOSPITAL DRIVE, SUITE 220, PALM COAST, FL 32164-2380
(386) 447-4408
Mailing address
28 OLD KINGS RD N, PALM COAST, FL 32137-8226
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
PENDING
FL
Other
Enumeration date
03/07/2008
Last updated
06/09/2008
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