Provider Demographics
NPI:1568437820
Name:FLORIDA ENDOSCOPY AND SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:FLORIDA ENDOSCOPY AND SURGERY CENTER, LLC
Other - Org Name:FLORIDA ENDOSCOPY & SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, PHYSICIANS BUSINESS SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PAT
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-778-1502
Mailing Address - Street 1:12900 CORTEZ BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6828
Mailing Address - Country:US
Mailing Address - Phone:352-596-1145
Mailing Address - Fax:352-596-7884
Practice Address - Street 1:12900 CORTEZ BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6828
Practice Address - Country:US
Practice Address - Phone:352-596-1145
Practice Address - Fax:352-596-7884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1104261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1024242OtherPHYSICIANS CARE PLAN
FL68POtherBCBS
FL490004769OtherMEDICARE RAILROAD
FL070553500Medicaid
FL6800147OtherUNITED HEALTHCARE INS
FLAS001104OtherSTERLING-MEDICARE CHOICE