Clay Surgery Center LLP

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

1176 Issued in FL

Legal business name

CLAY SURGERY CENTER LLP

Practice address

1564 Kingsley Avenue
Orange Park, FL 32073

Phone

(904) 264-0400

Fax

(904) 264-0401

NPI assigned

Dec 29, 2005

Last updated

Mar 13, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Esther Christine Lindeman

Title

Administrator

Phone

(904) 264-0400

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184601221. Details of each certification follow.

• CCN 100353 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 100353

Legal name

CLAY SURGERY CENTER LLP

Certification status

Terminated Voluntary: merger or closure, May 11, 2023

Provider type (POS)

Hospital – Short-term

Participating since

Aug 20, 2021

Last certification

Aug 20, 2021

Beds

1

Ownership / control type

Private (for profit)

Facility address

1564 Kingsley Ave
Orange Park, FL 32073

Listed as

Clay Surgery CenterCCN 10C0001398

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710288000000",
    "number": "1184601221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1564 KINGSLEY AVENUE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "32073",
            "telephone_number": "904-264-0400",
            "fax_number": "904-264-0401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1564 KINGSLEY AVENUE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "32073",
            "telephone_number": "904-264-0400",
            "fax_number": "904-264-0401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAY SURGERY CENTER LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-29",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A",
        "authorized_official_last_name": "LINDEMAN",
        "authorized_official_first_name": "ESTHER",
        "authorized_official_middle_name": "CHRISTINE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-264-0400"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "FL",
            "license": "1176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• CMS Imaging

• Ambulatory Surgical Clinic/Center in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Ambulatory Surgical Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.