MEDICARE: COGENT HEALTHCARE OF FORT MYERS, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	363L00000X	Nurse Practitioner
3	363A00000X	Physician Assistant
4	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	34480	OTHER	FL	BLUE CROSS BLUE SHEILD FL

General Provider Information

NPI Number	:	1952352163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COGENT HEALTHCARE OF FORT MYERS, LLC

Provider Business Mailing Address
First Line	:	5410 MARYLAND WAY
Second Line	:	SUITE 300
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-5064
Country	:	US
Telephone Number	:	615-377-5670
Fax Number	:	615-377-1687

Provider Business Practice Location Address
First Line	:	2776 CLEVELAND AVE
Second Line	:	CARE MANAGEMENT DEPARTMENT, 8TH FLOOR
City	:	FT MYERS
State	:	FL
Zip	:	33901-5864
Country	:	US
Telephone Number	:	239-344-5837
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	SUSAN A. BROWNIE
Credential	:
Telephone Number	:	615-377-5630

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	07/21/2008

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Directions to “COGENT HEALTHCARE OF FORT MYERS, LLC ” Practice Location

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