MEDICARE: RIVERWALK ENDOSCOPY AND 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	1236	FL

General Provider Information

NPI Number	:	1598735011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERWALK ENDOSCOPY AND SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	8380 RIVERWALK PARK BLVD
Second Line	:	SUITE 220
City	:	FORT MYERS
State	:	FL
Zip	:	33919-8758
Country	:	US
Telephone Number	:	239-454-7544
Fax Number	:	239-561-1124

Provider Business Practice Location Address
First Line	:	8380 RIVERWALK PARK BLVD
Second Line	:	SUITE 220
City	:	FORT MYERS
State	:	FL
Zip	:	33919-8758
Country	:	US
Telephone Number	:	239-454-7544
Fax Number	:	239-561-1124

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. DAGMAR WALKER
Credential	:	R.N.
Telephone Number	:	239-454-7544

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	12/18/2008

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