Ideal Body Institute Hudson ASC LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

IDEAL BODY INSTITUTE HUDSON ASC LLC

Practice address

14012 US Highway 19
Hudson, FL 34667-1165

Phone

(678) 466-6760

Fax

(678) 802-7094

NPI assigned

Apr 19, 2022

Organization subpart

No

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

Authorized official

Name

Christopher Ibikunle

Title

MD

Phone

(678) 466-6760

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1650326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650326400000",
    "number": "1821731753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "367 ATHENS HWY STE 100",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300522207",
            "telephone_number": "678-466-6760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14012 US HIGHWAY 19",
            "city": "HUDSON",
            "state": "FL",
            "postal_code": "346671165",
            "telephone_number": "678-466-6760",
            "fax_number": "678-802-7094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL BODY INSTITUTE HUDSON ASC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-19",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A",
        "authorized_official_last_name": "IBIKUNLE",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "678-466-6760"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Hudson, FL
• Providers in Hudson, 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 Apr 19, 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.