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General NPI Number Information
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NPI Number | 1912209800
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Entity Type | Organization
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Legal Business Name | SPECIALISTS IN UROLOGY SURGERY CENTER LLC
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Dates
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Enumeration Date | 11/26/2010
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 4571 COLONIAL BLVD SUITE 200
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City | FORT MYERS
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State | FL
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Zip | 33966
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Country | US
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Telephone | 239-434-6300
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Fax | 239-325-2285
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Provider Business Mailing Address
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Address Line | 4571 COLONIAL BLVD STE 200
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City | FORT MYERS
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State | FL
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Zip | 33966-1156
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Country | US
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Telephone | 239-963-7365
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Fax | 239-322-5617
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Authorized Official
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Title or Position | CHIEF ADMINISTRATIVE OFFICER
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Name | MS. JACQUELINE LUCIA
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Credential |
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Telephone | 239-963-7365
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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 | 1334
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License Number State | FL
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