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General NPI Number Information
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NPI Number | 1255674438
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Entity Type | Organization
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Legal Business Name | PHYSICIAN'S MANAGED SERVICES ORGANIZATION OF SOUTHWEST FLORIDA, LLC
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Dates
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Enumeration Date | 04/05/2013
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 1890 SW HEALTH PKWY SUITE 203
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City | NAPLES
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State | FL
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Zip | 34109-0473
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Country | US
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Telephone | 239-514-3131
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 CORPORATE CENTER WAY SUITE 200
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City | WELLINGTON
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State | FL
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Zip | 33414-2108
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Country | US
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Telephone | 561-623-8300
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS A BECKETT
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Credential | M.D
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Telephone | 239-514-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME58884
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License Number State | FL
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