Organization
JACKSONVILLE CHILDRENS SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEVIN LARSEN (CEO)
(208) 340-1840
Entity
Organization
Contact information
Practice address
3599 UNIVERSITY BLVD S STE 604, JACKSONVILLE, FL 32216-4234
(717) 759-4375
Mailing address
182 INDUSTRIAL RD, GLEN ROCK, PA 17327-8626
(717) 759-4375
(717) 759-4336
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
01/15/2021
Last updated
01/15/2021
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