1033103437 NPI number — SURGICAL SPECIALISTS OF SOUTHWEST FLORIDA P.A.

Table of content: (NPI 1033103437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033103437 NPI number — SURGICAL SPECIALISTS OF SOUTHWEST FLORIDA P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL SPECIALISTS OF SOUTHWEST FLORIDA P.A.
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:
Provider Other Organization Name Type Code:
6
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:
1033103437
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6821 PALISADES PARK CT
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33912-7131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-936-8555
Provider Business Mailing Address Fax Number:
239-936-5611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6821 PALISADES PARK CT
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33912-7131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-936-8555
Provider Business Practice Location Address Fax Number:
239-936-5611
Provider Enumeration Date:
08/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BURTCH
Authorized Official First Name:
GORDON
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
239-936-8555

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 052343700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com