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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