Provider Demographics
NPI:1881969269
Name:SURGERY CENTRE OF SW FLORIDA LLC
Entity type:Organization
Organization Name:SURGERY CENTRE OF SW FLORIDA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER / AUTHORIZED OFFICIAL
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:214-213-0723
Mailing Address - Street 1:665 DEL PRADO BLVD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-2666
Mailing Address - Country:US
Mailing Address - Phone:239-772-3636
Mailing Address - Fax:239-772-5073
Practice Address - Street 1:665 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2666
Practice Address - Country:US
Practice Address - Phone:239-772-3636
Practice Address - Fax:239-772-5073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10C0001571OtherCCN
FL1352OtherLICENSE
FLGX907AMedicare UPIN