Organization
AMELIA ISLAND SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. J. RUSSELL STACKHOUSE MD (MANAGER)
(904) 261-5741
Entity
Organization
Contact information
Practice address
2416 LYNNDALE RD, FERNANDINA BEACH, FL 32034-5201
(904) 261-5741
Mailing address
1005 W INDIANTOWN RD STE 101, JUPITER, FL 33458-6834
(561) 630-6277
(561) 630-6062
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2416
NONE
FL
Enumeration date
01/30/2021
Last updated
09/29/2021
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