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Organization
MEMORIAL SURGICARE LTD
Active
Organization
MEMORIAL SURGICARE LTD
Active
Other names
Plaza Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
DON LIEDTKE (VICE PRESIDENT)
(615) 344-5507
Entity
Organization
Contact information
Practice address
3901 UNIVERSITY BLVD S, SUITE 111, JACKSONVILLE, FL 32216-4377
(904) 448-1948
(904) 448-8889
Mailing address
3901 UNIVERSITY BLVD S, SUITE 111, JACKSONVILLE, FL 32216-4377
(904) 448-1948
(904) 448-8889
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
AHCA989
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
079198900
—
FL
Enumeration date
04/07/2006
Last updated
07/08/2008
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