Provider Demographics
NPI:1659360303
Name:ST. JOHNS SURGERY CENTER, LLC
Entity type:Organization
Organization Name:ST. JOHNS SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWENCKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-213-1447
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-8575
Mailing Address - Country:US
Mailing Address - Phone:864-359-1308
Mailing Address - Fax:
Practice Address - Street 1:8901 CONFERENCE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4895
Practice Address - Country:US
Practice Address - Phone:239-466-9555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. JOHNS SURGERY CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-17
Last Update Date:2025-09-03
Deactivation Date:2025-08-18
Deactivation Code:
Reactivation Date:2025-09-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1238OtherPTAN