Cape Coral FL Endoscopy ASC LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

910 Issued in FL

Legal business name

CAPE CORAL FL ENDOSCOPY ASC LLC

Doing business as

Lifeline Endoscopy Center

Practice address

665 Del Prado Blvd
Cape Coral, FL 33990-5630

Phone

(239) 772-8892

Fax

(239) 574-6262

NPI assigned

Mar 22, 2006

Last updated

May 15, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Billie A Payne

Title

President

Phone

(615) 665-1283

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Lifeline Endoscopy Center Doing business as

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

{
    "created_epoch": "1142985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242345600000",
    "number": "1457310831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "665 DEL PRADO BLVD",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339905630",
            "telephone_number": "239-772-8892",
            "fax_number": "239-574-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "665 DEL PRADO BLVD",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339905630",
            "telephone_number": "239-772-8892",
            "fax_number": "239-574-6262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPE CORAL FL ENDOSCOPY ASC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-22",
        "last_updated": "2009-05-15",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "BILLIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-665-1283",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "FL",
            "license": "910",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "076178800",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA MILITARY-TRICARE",
            "identifier": "621767599",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifeline Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ambulatory Surgical Clinic/Center in Cape Coral, FL
• Providers in Cape Coral, 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 May 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.