NPIMap

Organization Active NPI

Memorial Advanced Surgery

  • Specialist
  • Jacksonville, FL
National Provider Identifier
1083156202
Registry record updated Nov 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
035676 Issued in FL
Legal business name
MEMORIAL ADVANCED SURGERY
Practice address
3627 University Blvd S Ste 700
Jacksonville, FL 32216-7403
Phone
(904) 399-5678
Fax
(904) 399-8488
NPI assigned
Nov 7, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michelle Lewis
Title
Practice Manager
Phone
(904) 399-5678

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 035676 FL Primary

Addresses

Primary practice location

3627 University Blvd S Ste 700
Jacksonville, FL 32216-7403

Mailing address

3627 University Blvd S Ste 700
Jacksonville, FL 32216-7403
Phone (904) 399-5678

National Provider Directory

National Provider Directory
Tax ID family
Memorial Family Practice LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3627 University Blvd S
Ste 700
Jacksonville, FL 32216

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1478476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478476800000",
    "number": "1083156202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3627 UNIVERSITY BLVD S STE 700",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322167403",
            "telephone_number": "904-399-5678",
            "fax_number": "904-399-8488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3627 UNIVERSITY BLVD S STE 700",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322167403",
            "telephone_number": "904-399-5678",
            "fax_number": "904-399-8488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL ADVANCED SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-07",
        "last_updated": "2016-11-07",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "904-399-5678"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "035676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.