MEDICARE: CHARLOTTE ENDOSCOPIC SURGERY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	69Z	OTHER	FL	BC/BS FLORIDA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730175159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLOTTE ENDOSCOPIC SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	23970 SUNCOAST BLVD
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-2739
Country	:	US
Telephone Number	:	941-625-3636
Fax Number	:	941-764-7542

Provider Business Practice Location Address
First Line	:	23970 SUNCOAST BLVD
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-2739
Country	:	US
Telephone Number	:	941-625-3636
Fax Number	:	941-764-7542

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	COLLIN LEMAISTRE
Credential	:
Telephone Number	:	214-213-0732

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	08/15/2025

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