NPIMap

Organization Active NPI

Old Moultrie Surgical Center Inc

  • Ambulatory Surgical Clinic/Center
  • St Augustine, FL
National Provider Identifier
1144326307
Registry record updated Aug 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
1089 Issued in FL
Legal business name
OLD MOULTRIE SURGICAL CENTER INC
Practice address
2460 Old Moultrie Road
Suite 3
St Augustine, FL 32086-4198
Phone
(904) 797-6627
Fax
(904) 797-6028
NPI assigned
Sep 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2009

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

Authorized official

Name
George Edward Sadowski, MDNPI 1508830480
Title
Medical Director
Phone
(904) 797-6627

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 1089 FL Primary

Addresses

Primary practice location

2460 Old Moultrie Road
Suite 3
St Augustine, FL 32086-4198

Mailing address

P O Box 3127
St Augustine, FL 32085-3127
Phone (904) 797-6627

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090729000209 FL Part B Supplier - Ambulatory Surgical Center 1850321019 Practice locations: St Augustine, FL

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Old Moultrie Surgical Center IncCCN 10C0001317
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1249257600000",
    "number": "1144326307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 3127",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320853127",
            "telephone_number": "904-797-6627",
            "fax_number": "904-797-6028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2460 OLD MOULTRIE ROAD",
            "address_2": "SUITE 3",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320864198",
            "telephone_number": "904-797-6627",
            "fax_number": "904-797-6028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD MOULTRIE SURGICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2009-08-03",
        "status": "A",
        "authorized_official_last_name": "SADOWSKI",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "904-797-6627",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "FL",
            "license": "1089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.