Provider Demographics
NPI:1780967430
Name:SURGICAL HEALING ARTS CENTER, LLC
Entity type:Organization
Organization Name:SURGICAL HEALING ARTS CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIEH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-344-9786
Mailing Address - Street 1:6150 DIAMOND CENTRE COURT
Mailing Address - Street 2:SUITE 1301
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912
Mailing Address - Country:US
Mailing Address - Phone:239-344-9786
Mailing Address - Fax:239-344-9215
Practice Address - Street 1:6150 DIAMOND CENTRE COURT
Practice Address - Street 2:SUITE 1301
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912
Practice Address - Country:US
Practice Address - Phone:239-344-9786
Practice Address - Fax:239-344-9215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10312208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty