MEDICARE: CAPE CORAL FL ENDOSCOPY ASC 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	910	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	621767599	OTHER	FL	HUMANA MILITARY-TRICARE

General Provider Information

NPI Number	:	1457310831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPE CORAL FL ENDOSCOPY ASC LLC

Provider Business Mailing Address
First Line	:	665 DEL PRADO BLVD
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-5630
Country	:	US
Telephone Number	:	239-772-8892
Fax Number	:	239-574-6262

Provider Business Practice Location Address
First Line	:	665 DEL PRADO BLVD
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-5630
Country	:	US
Telephone Number	:	239-772-8892
Fax Number	:	239-574-6262

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. BILLIE A PAYNE
Credential	:
Telephone Number	:	615-665-1283

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	05/15/2009

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Directions to “CAPE CORAL FL ENDOSCOPY ASC LLC ” Practice Location

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