Healthcare Provider Details

I. General information

NPI: 1104092345
Provider Name (Legal Business Name): THE MCGREGOR CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3487 BROADWAY AVENUE
FORT MYERS FL
33901-7213
US

IV. Provider business mailing address

3487 BROADWAY AVENUE
FORT MYERS FL
33901-7213
US

V. Phone/Fax

Practice location:
  • Phone: 239-334-9555
  • Fax: 239-334-2439
Mailing address:
  • Phone: 239-334-9555
  • Fax: 239-334-2439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MR. BERT THOMAS HAMMOND
Title or Position: CEO
Credential:
Phone: 239-334-9555