Healthcare Provider Details

I. General information

NPI: 1588236954
Provider Name (Legal Business Name): SWF ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 RIVERWALK PARK BLVD STE 220
FORT MYERS FL
33919-8758
US

IV. Provider business mailing address

PO BOX 733926
DALLAS TX
75373-3926
US

V. Phone/Fax

Practice location:
  • Phone: 239-215-4104
  • Fax: 866-665-8561
Mailing address:
  • Phone: 888-851-4642
  • Fax: 866-665-8561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JEFF PERRY
Title or Position: VP OF REVENUE
Credential:
Phone: 502-418-4700