MEDICARE: ADVANCED LAPAROSCOPIC SURGERY OF FORT MYERS 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	208600000X	Surgery Physician	ME96681	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	178150564104	OTHER	FL	HUMANA
2	3954998	OTHER	FL	CIGNA
3	18294	OTHER	FL	BLUE CROSS BLUE SHIELD
4	2822788	OTHER	FL	UNITED
5	9344077	OTHER	FL	AETNA

General Provider Information

NPI Number	:	1780874784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED LAPAROSCOPIC SURGERY OF FORT MYERS LLC

Provider Business Mailing Address
First Line	:	615 WILLIAMS AVE
Second Line	:	SUITE 101
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33972-7954
Country	:	US
Telephone Number	:	239-209-7543
Fax Number	:	866-586-6004

Provider Business Practice Location Address
First Line	:	615 WILLIAMS AVE
Second Line	:	SUITE 101
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33972-7954
Country	:	US
Telephone Number	:	239-303-5273
Fax Number	:	866-586-6004

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PATRICK THOMAS MCGRAW
Credential	:	M. D.
Telephone Number	:	239-209-7543

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	07/23/2009

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