Healthcare Provider Details

I. General information

NPI: 1669050654
Provider Name (Legal Business Name): HEART & VASCULAR AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 01/31/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 BARKLEY CIR
FORT MYERS FL
33907-4539
US

IV. Provider business mailing address

1540 BARKLEY CIR
FORT MYERS FL
33907
US

V. Phone/Fax

Practice location:
  • Phone: 239-938-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARCI CHARLAND
Title or Position: CREDENTALING
Credential:
Phone: 239-919-4342