Healthcare Provider Details

I. General information

NPI: 1457156739
Provider Name (Legal Business Name): ADAM THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MAIN ST STE 100
FORT MYERS FL
33901-5502
US

IV. Provider business mailing address

2000 MAIN ST STE 100
FORT MYERS FL
33901-5502
US

V. Phone/Fax

Practice location:
  • Phone: 239-237-7592
  • Fax:
Mailing address:
  • Phone: 239-237-7592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number509463
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: