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General NPI Number Information
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NPI Number | 1588812945
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Entity Type | Organization
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Legal Business Name | FT. MYERS WOMEN'S HEALTH CENTER, INC.
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 08/28/2008
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Provider Practice Location Address
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Address Line | 3900 BROADWAY BLDG C
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City | FORT MYERS
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State | FL
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Zip | 33901-8193
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Country | US
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Telephone | 239-936-4497
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Fax | 941-936-0161
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Provider Business Mailing Address
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Address Line | 2106 DREW ST STE 103
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City | CLEARWATER
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State | FL
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Zip | 33765-3238
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Country | US
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Telephone | 727-442-0445
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Fax | 727-447-3797
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Authorized Official
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Title or Position | BILLING AND CONTRACT MANAGER
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Name | MARISELLA MARENGO
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Credential |
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Telephone | 727-442-0445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 828
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License Number State | FL
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