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General NPI Number Information
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NPI Number | 1265849830
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Entity Type | Organization
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Legal Business Name | SKILLED NURSING CARE MEDICAL GROUP LLC
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 08/01/2014
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Provider Practice Location Address
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Address Line | 2335 AARON ST
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5305
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Country | US
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Telephone | 855-670-7400
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Fax | 855-674-7401
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Provider Business Mailing Address
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Address Line | 3434 HANCOCK BRIDGE PKWY STE 301
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City | NORTH FORT MYERS
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State | FL
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Zip | 33903-7094
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Country | US
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Telephone | 877-856-3774
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Fax | 239-599-2625
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Authorized Official
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Title or Position | CFO
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Name | MR. DAVID KOENINGER
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Credential |
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Telephone | 855-674-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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