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General NPI Number Information
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NPI Number | 1336181742
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Entity Type | Organization
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Legal Business Name | PROMENADES SURGERY CENTER LLC
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 01/14/2013
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Provider Practice Location Address
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Address Line | 3222 TAMIAMI TRL
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8048
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Country | US
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Telephone | 941-627-5155
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Fax |
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Provider Business Mailing Address
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Address Line | 3222 TAMIAMI TRL
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8048
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Country | US
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Telephone | 941-627-5155
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ISSA F BAROUDI
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Credential | M.D.
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Telephone | 941-627-5155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 1149
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License Number State | FL
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