Healthcare Provider Details

I. General information

NPI: 1396217865
Provider Name (Legal Business Name): EKC MEDICAL SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 05/23/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 NICHOLAS PARKWAY NW SUITE 1
CAPE CORAL FL
33991-3804
US

IV. Provider business mailing address

290 NICHOLAS PKWY NW STE 1
CAPE CORAL FL
33991-3804
US

V. Phone/Fax

Practice location:
  • Phone: 239-573-1152
  • Fax: 239-573-1360
Mailing address:
  • Phone: 239-573-1152
  • Fax: 239-573-1360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RH0005X
TaxonomyHypertension Specialist Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHANNA C ALVAREZ
Title or Position: OWNER
Credential: NP
Phone: 239-994-8615