=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457448912
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLADIOLUS SURGERY CENTER , LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7431 GLADIOLUS SURGERY CENTER
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-689-7000
-----------------------------------------------------
Fax | 239-689-7007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7431 GLADIOLUS SURGERY CENTER
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-689-7000
-----------------------------------------------------
Fax | 239-689-7007
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | ANGELA PADRON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 239-689-7000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 1144
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------