Provider Demographics
NPI:1063500551
Name:CENTER FOR ADVANCED REPRODUCTIVE MEDICINE SURGERY, P.A.
Entity Type:Organization
Organization Name:CENTER FOR ADVANCED REPRODUCTIVE MEDICINE SURGERY, P.A.
Other - Org Name:C.A.R.M.S, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:ARMANDO
Authorized Official - Last Name:VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-444-1903
Mailing Address - Street 1:9530 BONITA BEACH ROAD
Mailing Address - Street 2:104
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135
Mailing Address - Country:US
Mailing Address - Phone:239-444-1903
Mailing Address - Fax:239-444-2393
Practice Address - Street 1:9530 BONITA BEACH ROAD
Practice Address - Street 2:104
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135
Practice Address - Country:US
Practice Address - Phone:239-444-1903
Practice Address - Fax:239-444-2393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD12530Medicare UPIN