Healthcare Provider Details

I. General information

NPI: 1134647886
Provider Name (Legal Business Name): COMMUNITY INTENSIVISTS OF FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 09/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 PINE RIDGE RD
NAPLES FL
34119-3900
US

IV. Provider business mailing address

30680 BAINBRIDGE RD
CLEVELAND OH
44139-2282
US

V. Phone/Fax

Practice location:
  • Phone: 440-542-5000
  • Fax: 440-542-5005
Mailing address:
  • Phone: 440-542-5000
  • Fax: 440-542-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN S MARTIN IV
Title or Position: MANAGING MEMBER
Credential:
Phone: 440-542-5000