NPIMap

Organization Active NPI

Island Surgery Center, Inc.

  • Ambulatory Surgical Clinic/Center
  • St Simons Island, GA
National Provider Identifier
1366620114
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
ISLAND SURGERY CENTER, INC.
Practice address
1015 Arthur J Moore Dr
St Simons Island, GA 31522-2206
Phone
(912) 634-1993
Fax
(912) 634-1166
NPI assigned
Feb 4, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Diane Gwyn Bowen, M.D.NPI 1215950431
Title
President
Phone
(912) 634-1993

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 GA Primary

Addresses

Primary practice location

1015 Arthur J Moore Dr
St Simons Island, GA 31522-2206

Mailing address

1015 Arthur J Moore Dr
St Simons Island, GA 31522-2206
Phone (912) 634-1993

National Provider Directory

National Provider Directory

Practitioners 1

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": "1202083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1366620114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 ARTHUR J MOORE DR",
            "city": "ST SIMONS ISLAND",
            "state": "GA",
            "postal_code": "315222206",
            "telephone_number": "912-634-1993",
            "fax_number": "912-634-1166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 ARTHUR J MOORE DR",
            "city": "ST SIMONS ISLAND",
            "state": "GA",
            "postal_code": "315222206",
            "telephone_number": "912-634-1993",
            "fax_number": "912-634-1166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND SURGERY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-04",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BOWEN",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "GWYN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "912-634-1993",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Simons Island, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.