Organization
JACKSONVILLE CHILDREN'S 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
(904) 525-8629
Mailing address
9709 LAKESIDE BLVD STE 350, SPRING, TX 77381-1213
(713) 489-2198
(713) 489-2978
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
390
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
683
BLUE CROSS BLUE SHIELD
FL
Enumeration date
01/31/2007
Last updated
01/27/2025
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