Healthcare Provider Details

I. General information

NPI: 1770566192
Provider Name (Legal Business Name): SUMMERLIN BEND SURGERY CENTER LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5238 MASON CORBIN CT STE 101
FT MYERS FL
33907-7738
US

IV. Provider business mailing address

5238 MASON CORBIN CT STE 101
FT MYERS FL
33907-7738
US

V. Phone/Fax

Practice location:
  • Phone: 239-936-9700
  • Fax: 239-936-9707
Mailing address:
  • Phone: 239-936-9700
  • Fax: 239-936-9707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. LISA L KELLEY
Title or Position: ADMINISTRATOR
Credential: RN MBA
Phone: 239-936-9700