MEDICARE: SOUTHWEST INTERNAL MEDICINE P A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	OS7553	FL

General Provider Information

NPI Number	:	1346287794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST INTERNAL MEDICINE P A

Provider Business Mailing Address
First Line	:	1708 CAPE CORAL PKWY W
Second Line	:	#4
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-6985
Country	:	US
Telephone Number	:	239-945-5940
Fax Number	:	239-945-5941

Provider Business Practice Location Address
First Line	:	1708 CAPE CORAL PKWY W
Second Line	:	#4
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-6985
Country	:	US
Telephone Number	:	239-945-5940
Fax Number	:	239-945-5941

Authorized Official
Title or Position	:	OWNER
Name	:	TRACY VO
Credential	:	DO
Telephone Number	:	239-945-5940

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	11/28/2007

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