MEDICARE: CAPE CORAL AMBULATORY SURGERY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	1245	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6N1	OTHER	FL	BLUE CROSS BLUE SHIELD FL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295772101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPE CORAL AMBULATORY SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	2721 DEL PRADO BLVD S
Second Line	:	SUITE 100
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-5781
Country	:	US
Telephone Number	:	239-242-8010
Fax Number	:	239-242-8020

Provider Business Practice Location Address
First Line	:	2721 DEL PRADO BLVD S
Second Line	:	SUITE 100
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-5781
Country	:	US
Telephone Number	:	239-242-8010
Fax Number	:	239-242-8020

Authorized Official
Title or Position	:	OFFICER AND AUTHORIZED OFFICIAL
Name	:	JENNIFER BOYD BALDOCK
Credential	:
Telephone Number	:	615-234-5954

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	03/01/2023

Similar Medicare Providers

1790788909 — BRADLEY W TROPE MD
Practice Location Address:

2721 DEL PRADO BLVD S , SUITE 200
CAPE CORAL, FL
33904-5781

Practice Phone: 239-772-3636
Practice Fax: 239-772-5073

1922001130 — WILLIAM R. KEITH JR. MD
Practice Location Address:

2721 DEL PRADO BLVD S , SUITE 200
CAPE CORAL, FL
33904-5781

Practice Phone: 239-772-3636
Practice Fax: 239-772-5073

1578560751 — HAROLD SCOTT HARRIS MD
Practice Location Address:

2721 DEL PRADO BLVD S , SUITE 200
CAPE CORAL, FL
33904-5781

Practice Phone: 239-772-3636
Practice Fax: 239-772-8903

1114915477 — KENNETH WILSON BACKSTRAND MD
Practice Location Address:

2721 DEL PRADO BLVD S
CAPE CORAL, FL
33904-5781

Practice Phone: 239-242-8010
Practice Fax: 239-242-8020

1881684322 — KATHLEEN A MURRAY CRNA
Practice Location Address:

2721 DEL PRADO BLVD S
CAPE CORAL, FL
33904-5781

Practice Phone: 239-242-8010
Practice Fax: 239-242-8020

1932142064 — PEDRO MONSERRATE M.D.
Practice Location Address:

2721 DEL PRADO BLVD S , SUITE 260
CAPE CORAL, FL
33904-5781

Practice Phone: 239-574-0011
Practice Fax: 239-574-4020

Directions to “CAPE CORAL AMBULATORY SURGERY CENTER, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.