Provider Demographics
NPI:1598735011
Name:RIVERWALK ENDOSCOPY AND SURGERY CENTER LLC
Entity Type:Organization
Organization Name:RIVERWALK ENDOSCOPY AND SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAGMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:239-454-7544
Mailing Address - Street 1:8380 RIVERWALK PARK BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-8758
Mailing Address - Country:US
Mailing Address - Phone:239-454-7544
Mailing Address - Fax:239-561-1124
Practice Address - Street 1:8380 RIVERWALK PARK BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-8758
Practice Address - Country:US
Practice Address - Phone:239-454-7544
Practice Address - Fax:239-561-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1236261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1454Medicare ID - Type UnspecifiedFACILITY PROVIDER NUMBER