Healthcare Provider Details

I. General information

NPI: 1629262811
Provider Name (Legal Business Name): PREMIER ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1656 MEDICAL BLVD SUITE 201
NAPLES FL
34110-1423
US

IV. Provider business mailing address

1656 MEDICAL BLVD SUITE 201
NAPLES FL
34110-1423
US

V. Phone/Fax

Practice location:
  • Phone: 239-593-6201
  • Fax: 239-593-6203
Mailing address:
  • Phone: 239-593-6201
  • Fax: 239-593-6203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1283
License Number StateFL

VIII. Authorized Official

Name: DR. STEVEN A MECKSTROTH
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 239-287-9481