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General NPI Number Information
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NPI Number | 1497750400
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Entity Type | Organization
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Legal Business Name | PLAZA SURGERY, G.P.
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 979 E 3RD ST
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City | CHATTANOOGA
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State | TN
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Zip | 37403-2136
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Country | US
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Telephone | 423-778-3192
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Fax | 423-778-2164
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Provider Business Mailing Address
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Address Line | 13740 CYPRESS TERRACE CIR STE 501-503
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City | FORT MYERS
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State | FL
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Zip | 33907-8827
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Country | US
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Telephone | 239-274-1000
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Fax | 239-274-1001
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MS. DAWN HURST
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Credential |
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Telephone | 423-778-3192
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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 | 0000000135
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License Number State | TN
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