Provider Demographics
NPI:1912953290
Name:NORTH FLORIDA SURGEONS, PA
Entity type:Organization
Organization Name:NORTH FLORIDA SURGEONS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-396-1725
Mailing Address - Street 1:PO BOX 14009
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4031
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-399-1717
Practice Address - Street 1:11945 SAN JOSE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-1627
Practice Address - Country:US
Practice Address - Phone:904-396-1725
Practice Address - Fax:904-396-4893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1912953290208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255867000Medicaid
GA300038939CMedicaid
FLCB9176OtherRAILROAD MEDICARE
40594OtherBLUE CROSS BLUE SHIELD
FL255867000Medicaid
FL5861470001Medicare NSC
FL40594BMedicare PIN
FL40594Medicare PIN