=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780967430
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SURGICAL HEALING ARTS CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2011
-----------------------------------------------------
Last Update Date | 09/25/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6150 DIAMOND CENTRE COURT SUITE 1301
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-344-9786
-----------------------------------------------------
Fax | 239-344-9215
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6150 DIAMOND CENTRE COURT SUITE 1301
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-344-9786
-----------------------------------------------------
Fax | 239-344-9215
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. MOSES SHIEH
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 239-344-9786
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | OS10312
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------