Provider Demographics
NPI:1750363461
Name:BARKLEY SURGICENTER, LLC
Entity type:Organization
Organization Name:BARKLEY SURGICENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARKET PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMAISTRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-213-0732
Mailing Address - Street 1:63 BARKLEY CIR STE 104
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4514
Mailing Address - Country:US
Mailing Address - Phone:239-275-8452
Mailing Address - Fax:239-274-3182
Practice Address - Street 1:63 BARKLEY CIR STE 104
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4514
Practice Address - Country:US
Practice Address - Phone:239-275-8452
Practice Address - Fax:239-274-3182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL823261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL490002295OtherRAILROAD MEDICARE
FL63QOtherBCBS
FL0857955OtherCIGNA
FL8720114OtherAETNA
FL490002295OtherRAILROAD MEDICARE
FL63QOtherBCBS
FLF1192Medicare PIN