1023433984 NPI number — PHYSICIANS FOR QUALITY HEALTHCARE, INC.

Table of content: (NPI 1023433984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023433984 NPI number — PHYSICIANS FOR QUALITY HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS FOR QUALITY HEALTHCARE, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1023433984
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6150 DIAMOND CENTRE CT
Provider Second Line Business Mailing Address:
BLDG 100
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-768-6396
Provider Business Mailing Address Fax Number:
239-204-3000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6444 BEACH BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32216-2891
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-768-6396
Provider Business Practice Location Address Fax Number:
239-204-3000
Provider Enumeration Date:
02/28/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GHANEM
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
239-768-6396

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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