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General NPI Number Information
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NPI Number | 1609537992
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Entity Type | Organization
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Legal Business Name | NCH BONITA AMBULATORY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 01/07/2022
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 24040 S TAMIAMI TRL STE 201
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-7040
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Country | US
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Telephone | 239-624-6930
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Fax |
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Provider Business Mailing Address
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Address Line | 24040 S TAMIAMI TRL STE 201
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-7040
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Country | US
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Telephone | 239-624-6930
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Fax |
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Authorized Official
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Title or Position | BOARD MEMBER/ADMINISTRATOR
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Name | MRS. TRINA FAGER
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Credential | RN, BSN, CNOR
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Telephone | 239-624-6946
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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 |
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License Number State |
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