Organization
ATLANTIC SURGERY CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY L CANTWELL M.D. (PRESIDENT)
(386) 239-0021
Entity
Organization
Contact information
Practice address
541 HEALTH BLVD, DAYTONA BEACH, FL 32114-1493
(386) 239-0021
(386) 248-8226
Mailing address
541 HEALTH BLVD, DAYTONA BEACH, FL 32114-1493
(386) 239-0021
(386) 248-8226
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
1020
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006574700
—
FL
01
—
1495361
UNITED MINE WORKERS
FL
01
—
64J
BLUE CROSS AND BLUE SHIEL
FL
Enumeration date
08/07/2006
Last updated
05/11/2017
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