Provider Demographics
NPI:1598846925
Name:SURGICARE CENTER LLC
Entity Type:Organization
Organization Name:SURGICARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWENCKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-213-1385
Mailing Address - Street 1:4101 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9310
Mailing Address - Country:US
Mailing Address - Phone:239-275-1176
Mailing Address - Fax:239-790-2432
Practice Address - Street 1:4101 EVANS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9310
Practice Address - Country:US
Practice Address - Phone:239-275-1176
Practice Address - Fax:239-790-2432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800009615261QS0132X
FLPH10568261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062937500Medicaid
10C0001029OtherCCN
FL062937500Medicaid