Provider Demographics
NPI:1053031872
Name:ST. BARBARA'S SURGERY CENTER, LLC
Entity type:Organization
Organization Name:ST. BARBARA'S SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF RCM
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-291-6293
Mailing Address - Street 1:44 BARKLEY CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7530
Mailing Address - Country:US
Mailing Address - Phone:239-985-7171
Mailing Address - Fax:239-985-7118
Practice Address - Street 1:1745 HERITAGE TRL
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-7591
Practice Address - Country:US
Practice Address - Phone:239-350-3389
Practice Address - Fax:239-350-3390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRB456OtherPTAN