Healthcare Provider Details

I. General information

NPI: 1124125604
Provider Name (Legal Business Name): MURDOCK AMBULATORY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 EDUCATION WAY
PORT CHARLOTTE FL
33948-1000
US

IV. Provider business mailing address

1400 EDUCATION WAY
PORT CHARLOTTE FL
33948-1000
US

V. Phone/Fax

Practice location:
  • Phone: 941-625-9800
  • Fax: 941-625-3492
Mailing address:
  • Phone: 941-625-9800
  • Fax: 941-625-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1258
License Number StateFL

VIII. Authorized Official

Name: COLLIN LEMAISTRE
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 469-250-3640