Provider Demographics
NPI:1538943980
Name:OUTPATIENT SERVICE PROVIDERS LLC
Entity type:Organization
Organization Name:OUTPATIENT SERVICE PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-BAHRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-686-6020
Mailing Address - Street 1:9726 TOUCHTON RD STE 305
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8307
Mailing Address - Country:US
Mailing Address - Phone:904-686-6020
Mailing Address - Fax:
Practice Address - Street 1:9726 TOUCHTON RD STE 305
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-8307
Practice Address - Country:US
Practice Address - Phone:904-686-6020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:F1618
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty