1558518456 NPI number — FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA INC

Table of content: (NPI 1558518456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558518456 NPI number — FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA 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:
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:
1558518456
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 919771
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32891-9771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-278-3600
Provider Business Mailing Address Fax Number:
239-278-3857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11921 SARADRIENNE LN
Provider Second Line Business Practice Location Address:
#8
Provider Business Practice Location Address City Name:
BONITA SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34135-5911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-344-2322
Provider Business Practice Location Address Fax Number:
239-390-0523
Provider Enumeration Date:
08/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MAZZEO
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
239-278-3600

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 029570120 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com