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General NPI Number Information
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NPI Number | 1295373660
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Entity Type | Organization
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Legal Business Name | CALOOSA MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 12/17/2019
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Last Update Date | 12/17/2019
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Provider Practice Location Address
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Address Line | 14651 PALM BEACH BLVD STE 100
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City | FORT MYERS
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State | FL
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Zip | 33905-2331
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Country | US
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Telephone | 239-849-6620
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Fax |
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Provider Business Mailing Address
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Address Line | 5180 JACKSON RD
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City | FORT MYERS
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State | FL
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Zip | 33905-7518
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Country | US
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Telephone | 239-849-6620
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. CLARENNCE A SCOTT
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Credential | D.O.
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Telephone | 239-849-6620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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