Provider Demographics
NPI:1093748907
Name:SPECIALISTS IN UROLOGY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SPECIALISTS IN UROLOGY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:FIGLESTHALER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-434-6300
Mailing Address - Street 1:990 TAMIAMI TRAIL NORTH
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5403
Mailing Address - Country:US
Mailing Address - Phone:239-434-6300
Mailing Address - Fax:239-434-8398
Practice Address - Street 1:990 TAMIAMI TRL N
Practice Address - Street 2:SUITE 100
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5403
Practice Address - Country:US
Practice Address - Phone:239-434-6300
Practice Address - Fax:239-434-8398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1177261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075586900Medicaid
FLF1402Medicare PIN
FL075586900Medicaid
FLP00085604Medicare PIN