1528379344 NPI number — RJ3 SWFL

Table of content: (NPI 1528379344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528379344 NPI number — RJ3 SWFL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RJ3 SWFL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FIRST CHOICE PAIN CARE CLINIC SWFL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528379344
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 COMMERCIAL CT
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
VENICE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34292-1652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-480-0200
Provider Business Mailing Address Fax Number:
941-485-8404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13100 WESTLINKS TER
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33913-8624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-332-2360
Provider Business Practice Location Address Fax Number:
239-332-0830
Provider Enumeration Date:
06/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SLOAN
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
941-480-0200

Provider Taxonomy Codes

  • Taxonomy code: 261QP3300X , with the licence number:  HCC8550 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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