SURGCENTER OF PINE RIDGE LLC NPI 1285202077

NPI Information

NPI: 1285202077
Provider Name: SURGCENTER OF PINE RIDGE LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 10D2228152

Address:
12871 TRADE WAY DR
STE 12
BONITA SPRINGS, FL
ZIP 34135
Phone: (239) 478-0051
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SURGCENTER OF PINE RIDGE LLC is an ambulatory surgical clinic center in Bonita Springs, FL. SURGCENTER OF PINE RIDGE LLC NPI is 1285202077. The provider is registered as an organization entity type.

The provider's business location address is:

12871 TRADE WAY DR
STE 12
BONITA SPRINGS, FL
ZIP 34135-334
Phone: (239) 478-0051

The provider's authorized official is Eric M Johnson .
The authorized official title is Ceo and has the following contact phone number (239) 478-0051.

The CLIA number assigned to this NPI record is 10D2228152 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/16/2021 and was last updated on 8/20/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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