Healthcare Provider Details

I. General information

NPI: 1659360303
Provider Name (Legal Business Name): ST. JOHNS SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 09/03/2025
Certification Date: 08/13/2025
Deactivation Date: 08/18/2025
Reactivation Date: 09/03/2025

III. Provider practice location address

8901 CONFERENCE DR
FORT MYERS FL
33919-4895
US

IV. Provider business mailing address

PO BOX 11407
BIRMINGHAM AL
35246-8575
US

V. Phone/Fax

Practice location:
  • Phone: 239-466-9555
  • Fax:
Mailing address:
  • Phone: 864-359-1308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN SWENCKI
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 941-213-1447