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General NPI Number Information
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NPI Number | 1659360303
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Entity Type | Organization
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Legal Business Name | ST. JOHNS SURGERY CENTER, LLC
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 8901 CONFERENCE DR
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City | FORT MYERS
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State | FL
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Zip | 33919-4895
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Country | US
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Telephone | 239-466-9555
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11407
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City | BIRMINGHAM
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State | AL
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Zip | 35246-8575
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Country | US
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Telephone | 864-359-1308
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JOHN SWENCKI
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Credential |
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Telephone | 941-213-1447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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