Organization
2096 EAST OCEAN BOULEVARD, LC
Active
Other names
Surgery Center of Stuart
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BARBARA ANN TIDWELL (ADMINISTRATOR)
(772) 223-0174
Entity
Organization
Contact information
Practice address
2096 SE OCEAN BLVD, STUART, FL 34996-3304
(772) 223-0174
(772) 223-0558
Mailing address
2096 SE OCEAN BLVD, STUART, FL 34996-3304
(772) 223-0174
(772) 223-0558
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
901
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0097410006
CIGNA
FL
05
—
079144000
—
FL
01
—
490004057
RAILROAD MEDICARE
FL
01
—
61D
BCBS
FL
Enumeration date
11/20/2006
Last updated
02/02/2012
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