Provider Demographics
NPI:1023259637
Name:NEUROSURGICAL ASSOCIATES OF ST AUGUSTINE LLC
Entity type:Organization
Organization Name:NEUROSURGICAL ASSOCIATES OF ST AUGUSTINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACHADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-819-4088
Mailing Address - Street 1:PO BOX 3185
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-3185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 HEALTH PARK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5794
Practice Address - Country:US
Practice Address - Phone:904-819-4088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47757207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96891OtherBCBS
FL002068600Medicaid
FL002068600Medicaid