Organization
COLONIAL OUTPATIENT SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKY LUCIA (CHIEF ADMINISTRATIVE OFFICER)
(239) 963-7365
Entity
Organization
Contact information
Practice address
4571 COLONIAL BLVD, FORT MYERS, FL 33966-1156
(239) 333-2050
Mailing address
4571 COLONIAL BLVD, FORT MYERS, FL 33966-1156
(239) 333-2050
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
08/23/2018
Last updated
08/23/2018
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