NPIMap

Organization Active NPI

Surgical Associates of North Florida LLC

  • Surgery Physician
  • St Augustine, FL
National Provider Identifier
1417054826
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
ME54115 Issued in FL
Legal business name
SURGICAL ASSOCIATES OF NORTH FLORIDA LLC
Practice address
2460 Old Moultrie Road
Suite 2
St Augustine, FL 32086-4198
Phone
(904) 797-6627
Fax
(904) 797-6028
NPI assigned
Sep 20, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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
Director
Phone
(904) 797-6627

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X ME87867 FL
Surgery Physician 208600000X ME54115 FL Primary

Addresses

Primary practice location

2460 Old Moultrie Road
Suite 2
St Augustine, FL 32086-4198

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
062191900MedicaidFL
269607000MedicaidFL

National Provider Directory

National Provider Directory

Locations

199 N Highway 17
Palatka, FL 32177
Phone (904) 797-6627

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417054826",
    "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 2",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320864198",
            "telephone_number": "904-797-6627",
            "fax_number": "904-797-6028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICAL ASSOCIATES OF NORTH FLORIDA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SADOWSKI",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "904-797-6627",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME87867",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME54115",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "062191900",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269607000",
            "state": "FL"
        }
    ],
    "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 22, 2020; 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.