MEDICARE: FWC PERINATAL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VM0101X	Maternal & Fetal Medicine Physician

General Provider Information

NPI Number	:	1881481778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FWC PERINATAL, LLC

Provider Business Mailing Address
First Line	:	PO BOX 81798
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44181-0798
Country	:	US
Telephone Number	:	561-300-2410
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 SE PORT ST LUCIE BLVD STE B
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34984-5141
Country	:	US
Telephone Number	:	561-626-3800
Fax Number	:	561-820-2911

Authorized Official
Title or Position	:	PROVIDER ENROLLMENT
Name	:	TAMMY WALKER
Credential	:
Telephone Number	:	561-300-2410

Provider Enumeration Date	:	04/23/2025
Last Update Date	:	04/23/2025

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