Provider Demographics
NPI:1386647402
Name:PHYSICIANS DAY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:PHYSICIANS DAY SURGERY CENTER, LLC
Other - Org Name:PHYSICIANS DAY SURGERY CENTER, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:DIONNE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-596-2557
Mailing Address - Street 1:850 111TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-1803
Mailing Address - Country:US
Mailing Address - Phone:239-596-2557
Mailing Address - Fax:239-596-2563
Practice Address - Street 1:850 111TH AVE N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1803
Practice Address - Country:US
Practice Address - Phone:239-596-2557
Practice Address - Fax:239-596-2563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1065261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023127700Medicaid
FL070466100Medicaid