JACKSONVILLE AMBULATORY SURGERY CENTER, LLC
NPI 1497614986
Clinic/Center - Ambulatory Surgical in St. Johns, FL
About Jacksonville Ambulatory Surgery Center, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACKSONVILLE AMBULATORY SURGERY CENTER, LLC (NPI 1497614986) is a healthcare organization registered as an ambulatory surgical in St. Johns, Florida and active in the NPI registry since January 2026. The organization holds a CLIA Waiver certificate valid through August 5, 2028 and lists Jamie Thibodeaux, Chief Administrative Officer, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 10D2348489
Jacksonville Ambulatory Surgery Center Dba Surgery Center Of Durbin · St Johns, FLFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jacksonville Ambulatory Surgery Center, LLC's NPI number?
The NPI number for Jacksonville Ambulatory Surgery Center, LLC is 1497614986. It was assigned to this organization in the NPPES registry on January 20, 2026.
Where is Jacksonville Ambulatory Surgery Center, LLC located?
Jacksonville Ambulatory Surgery Center, LLC is located at 75 Barren Way, St. Johns, FL 32259. The listed phone number is (904) 889-0061.
What is Jacksonville Ambulatory Surgery Center, LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.
Does Jacksonville Ambulatory Surgery Center, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 10D2348489) is associated with this NPI, valid through August 5, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Jacksonville Ambulatory Surgery Center, LLC was last updated on June 26, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Jacksonville Ambulatory Surgery Center, Llc · NPI 1497614986
Ambulatory Surgical organization in St. Johns, Florida. Organization record, active in the CMS NPPES registry since January 20, 2026.
## Identity
- **NPI:** 1497614986 (Entity type: Organization)
- **Enumerated:** January 20, 2026
- **Primary specialty:** Clinic/Center - Ambulatory Surgical · taxonomy 261QA1903X
- **Organization subpart:** No
- **Authorized official:** Jamie Thibodeaux, CHIEF ADMINISTRATIVE OFFICER
## Practice location
- **Address:** 75 BARREN WAY, St. Johns, FL 32259
- **Phone:** (904) 889-0061
## Record status
- **NPPES last updated:** June 26, 2026
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1497614986) · Data from the CMS NPPES public registry.