=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003812686
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLORIDA COASTAL SURGERY CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2005
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 ANCHOR RODE DRIVE SUITE 100
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34103-2742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-263-1717
-----------------------------------------------------
Fax | 239-403-9410
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 ANCHOR RODE DRIVE SUITE 100
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34103-2742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-263-1717
-----------------------------------------------------
Fax | 239-403-9410
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | MS. NICOLE M. BABB
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 239-263-1717
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 1067
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------