Provider Demographics
NPI:1942454095
Name:PACAYA BAY SURGERY CENTER LLC
Entity Type:Organization
Organization Name:PACAYA BAY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RITROSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-275-4505
Mailing Address - Street 1:13981 MCGREGOR BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919
Mailing Address - Country:US
Mailing Address - Phone:239-275-4505
Mailing Address - Fax:239-275-9933
Practice Address - Street 1:13981 MCGREGOR BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919
Practice Address - Country:US
Practice Address - Phone:239-275-4505
Practice Address - Fax:239-275-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical