Provider Demographics
NPI:1609537992
Name:NCH BONITA AMBULATORY SURGERY CENTER, LLC
Entity type:Organization
Organization Name:NCH BONITA AMBULATORY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, CNOR
Authorized Official - Phone:239-624-6946
Mailing Address - Street 1:24040 S TAMIAMI TRL STE 201
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7040
Mailing Address - Country:US
Mailing Address - Phone:239-624-6930
Mailing Address - Fax:
Practice Address - Street 1:24040 S TAMIAMI TRL STE 201
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7040
Practice Address - Country:US
Practice Address - Phone:239-624-6930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical