Fort Myers Children'S Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

FORT MYERS CHILDREN'S SURGERY CENTER, LLC

Practice address

3700 Central Ave
# 2
Ft Myers, FL 33901

Phone

(239) 275-0665

Fax

(239) 275-0503

NPI assigned

Sep 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Devin Larsen

Title

Ceo

Phone

(208) 340-1840

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Southwest Florida Institute of Ambulatory Surgery Inc Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Listed as

Southwest Florida Institute of Ambulatory SurgeryCCN 10C0001020

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737936000000",
    "number": "1366549511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9709 LAKESIDE BLVD STE 350",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773811213",
            "telephone_number": "713-489-2198",
            "fax_number": "713-489-2978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 CENTRAL AVE",
            "address_2": "# 2",
            "city": "FT MYERS",
            "state": "FL",
            "postal_code": "33901",
            "telephone_number": "239-275-0665",
            "fax_number": "239-275-0503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT MYERS CHILDREN'S SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "DEVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-340-1840"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "490000379",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwest Florida Institute of Ambulatory Surgery Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southwest Florida Institute of Ambulatory Surgery Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brooke Lyall Foris, PSY.D.
• Ivian Forjans Perez
• Jacquelyn Rae Forsythe, ARNP
• Fort Myers Central Chiropractic LLC
• Fort Myers Centre for Facial Plastic and Laser Surgery, Inc.
• Fort Myers Chiropractic & Nutrition Center, Inc.
• Fort Myers Chiropractic Studio LLC
• Fort Myers Dental Arts
• Fort Myers Dermatopathology
• Fort Myers Dermatopathology PA

• Ambulatory Surgical Clinic/Center in Ft Myers, FL
• Providers in Ft Myers, FL by specialty
• Ambulatory Surgical Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.