Healthcare Provider Details

I. General information

NPI: 1801458989
Provider Name (Legal Business Name): MILLENNIUM SURGERY CENTERS OF FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
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

6321 DANIELS PKWY STE 200
FORT MYERS FL
33912-4773
US

V. Phone/Fax

Practice location:
  • Phone: 855-674-7400
  • Fax: 855-674-7401
Mailing address:
  • Phone: 855-674-7400
  • Fax: 855-674-7400

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: KEVIN KEARNS
Title or Position: CEO
Credential:
Phone: 855-674-7400