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Organization
AMELIA ISLAND SURGERY CENTER LLC
Active
Organization
AMELIA ISLAND SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. J. RUSSELL STACKHOUSE MD (MANAGER)
(904) 261-5741
Entity
Organization
Contact information
Practice address
2416 LYNNDALE RD, FERNANDINA BEACH, FL 32034-5201
(904) 261-5741
Mailing address
1005 W INDIANTOWN RD STE 101, JUPITER, FL 33458-6834
(561) 630-6277
(561) 630-6062
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2416
NONE
FL
Enumeration date
01/30/2021
Last updated
09/29/2021
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