MEDICARE: PHYSICIANS FOR QUALITY HEALTHCARE,INC

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	261QP2000X	Physical Therapy Clinic/Center
2	261QM1300X	Multi-Specialty Clinic/Center	HCC9815	FL

General Provider Information

NPI Number	:	1932503851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS FOR QUALITY HEALTHCARE,INC

Provider Business Mailing Address
First Line	:	6150 DIAMOND CENTRE CT BLDG 100
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4367
Country	:	US
Telephone Number	:	239-768-6396
Fax Number	:	239-204-3000

Provider Business Practice Location Address
First Line	:	413 DEL PRADO BLVD S STE 201
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-5703
Country	:	US
Telephone Number	:	239-768-6396
Fax Number	:	239-204-3000

Authorized Official
Title or Position	:	CEO
Name	:	MR. GEORGE GHANEM
Credential	:
Telephone Number	:	239-768-6396

Provider Enumeration Date	:	10/21/2014
Last Update Date	:	08/21/2020

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