Healthcare Provider Details

I. General information

NPI: 1053031872
Provider Name (Legal Business Name): ST. BARBARA'S SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 HERITAGE TRL
NAPLES FL
34112-7591
US

IV. Provider business mailing address

44 BARKLEY CIR
FORT MYERS FL
33907-7530
US

V. Phone/Fax

Practice location:
  • Phone: 239-350-3389
  • Fax: 239-350-3390
Mailing address:
  • Phone: 239-985-7171
  • Fax: 239-985-7118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEWIS WOODELL
Title or Position: VP OF RCM
Credential:
Phone: 817-291-6293