MEDICARE: FLORIDA COMMUNITY HEALTH CENTERS, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	207V00000X	Obstetrics & Gynecology Physician
3	208000000X	Pediatrics Physician
4	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1346619244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA COMMUNITY HEALTH CENTERS, INC.

Provider Business Mailing Address
First Line	:	5827 CORPORATE WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2000
Country	:	US
Telephone Number	:	561-844-9443
Fax Number	:	561-844-1013

Provider Business Practice Location Address
First Line	:	3235 SW PORT ST LUCIE BLVD
Second Line	:	SUITE 105
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-3405
Country	:	US
Telephone Number	:	561-844-9443
Fax Number	:	561-844-1013

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	DR. MICHAEL F GERVASI
Credential	:	D.O.
Telephone Number	:	561-844-9443

Provider Enumeration Date	:	09/21/2015
Last Update Date	:	06/17/2016

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