=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487030870
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHWEST GENERAL HEALTHCARE CENTER CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2015
-----------------------------------------------------
Last Update Date | 07/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29 BARKLEY CIR
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33907-7531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-931-3366
-----------------------------------------------------
Fax | 239-931-1262
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 BARKLEY CIR
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33907-7531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-931-3366
-----------------------------------------------------
Fax | 239-931-1262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PRESIDENT
-----------------------------------------------------
Name | MR. YOEL A SANTANA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 239-719-0157
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | EXEMPT
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------