1568437820 NPI number — FLORIDA ENDOSCOPY AND SURGERY CENTER, LLC

Table of content: (NPI 1568437820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568437820 NPI number — FLORIDA ENDOSCOPY AND SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA ENDOSCOPY AND SURGERY CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FLORIDA ENDOSCOPY & SURGERY CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568437820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12900 CORTEZ BLVD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
BROOKSVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34613-6828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-596-1145
Provider Business Mailing Address Fax Number:
352-596-7884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12900 CORTEZ BLVD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
BROOKSVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34613-6828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-596-1145
Provider Business Practice Location Address Fax Number:
352-596-7884
Provider Enumeration Date:
02/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
PAT
Authorized Official Title or Position:
VP, PHYSICIANS BUSINESS SERVICES
Authorized Official Telephone Number:
615-778-1502

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  1104 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1024242 . This is a "PHYSICIANS CARE PLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 68P . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 490004769 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 070553500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6800147 . This is a "UNITED HEALTHCARE INS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: AS001104 . This is a "STERLING-MEDICARE CHOICE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 070553500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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