Healthcare Provider Details

I. General information

NPI: 1043156136
Provider Name (Legal Business Name): UGO AIRPORT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3252 PALM AVE
FORT MYERS FL
33901-7428
US

IV. Provider business mailing address

3252 PALM AVE
FORT MYERS FL
33901-7428
US

V. Phone/Fax

Practice location:
  • Phone: 941-333-1234
  • Fax: 941-333-1234
Mailing address:
  • Phone: 941-333-1234
  • Fax: 941-333-1234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. CLYDE GEORGE PUTNAM
Title or Position: CEO
Credential: PUTNAM
Phone: 941-333-1234