=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457003725
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLORIDA COMMUNITY HEALTH CENTERS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2022
-----------------------------------------------------
Last Update Date | 01/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5827 CORPORATE WAY STE 135
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33407-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-612-6524
-----------------------------------------------------
Fax | 561-844-1013
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5827 CORPORATE WAY
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33407-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-844-9443
-----------------------------------------------------
Fax | 561-844-1013
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & CEO
-----------------------------------------------------
Name | WILHELMINA N. LEWIS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 561-844-9443
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------