Provider Demographics
NPI:1215097845
Name:NEWGATE SURGERY CENTER INC
Entity type:Organization
Organization Name:NEWGATE SURGERY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-263-6766
Mailing Address - Street 1:5200 TAMIAMI TRL N
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-2817
Mailing Address - Country:US
Mailing Address - Phone:239-263-6766
Mailing Address - Fax:239-263-3320
Practice Address - Street 1:5200 TAMIAMI TRL N
Practice Address - Street 2:SUITE 202
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-2817
Practice Address - Country:US
Practice Address - Phone:239-263-6766
Practice Address - Fax:239-263-3320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL843261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL079196200Medicaid
FLF1243Medicare ID - Type Unspecified