Provider Demographics
NPI:1992970230
Name:PARK CENTER FOR PROCEDURES LLC
Entity type:Organization
Organization Name:PARK CENTER FOR PROCEDURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAITCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-437-8000
Mailing Address - Street 1:PO BOX 07122
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-0122
Mailing Address - Country:US
Mailing Address - Phone:239-267-2900
Mailing Address - Fax:239-337-6866
Practice Address - Street 1:8255 COLLEGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5119
Practice Address - Country:US
Practice Address - Phone:239-267-2900
Practice Address - Fax:239-337-6866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical