Organization
FORT MYERS CHILDREN'S SURGERY CENTER, LLC
Active
Other names
Southwest Florida Institute of Ambulatory Surgery Inc
Organization subpart
No
Provider details
NPI number
Authorized official
DEVIN LARSEN (CEO)
(208) 340-1840
Entity
Organization
Contact information
Practice address
3700 CENTRAL AVE, # 2, FT MYERS, FL 33901
(239) 275-0665
(239) 275-0503
Mailing address
9709 LAKESIDE BLVD STE 350, SPRING, TX 77381-1213
(713) 489-2198
(713) 489-2978
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
490000379
RAILROAD MEDICARE
FL
Enumeration date
09/20/2006
Last updated
01/27/2025
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