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Organization
CAPE CORAL FL ENDOSCOPY ASC LLC
Active
Organization
CAPE CORAL FL ENDOSCOPY ASC LLC
Active
Other names
Lifeline Endoscopy Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BILLIE A PAYNE (PRESIDENT)
(615) 665-1283
Entity
Organization
Contact information
Practice address
665 DEL PRADO BLVD, CAPE CORAL, FL 33990-5630
(239) 772-8892
(239) 574-6262
Mailing address
665 DEL PRADO BLVD, CAPE CORAL, FL 33990-5630
(239) 772-8892
(239) 574-6262
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
910
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
076178800
—
FL
01
—
621767599
HUMANA MILITARY-TRICARE
FL
Enumeration date
03/22/2006
Last updated
05/15/2009
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