Organization
IPS OF JACKSONVILLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL R NOBACK MD (MEMBER)
(941) 360-1566
Entity
Organization
Contact information
Practice address
4754 E STATE ROAD 64, BRADENTON, FL 34208-9058
(888) 337-3509
(941) 328-3997
Mailing address
PO BOX 864483, ORLANDO, FL 32886-4483
(888) 337-3509
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
1176
FL
Other
Enumeration date
12/10/2008
Last updated
01/10/2017
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