MEDICARE: LUXVIL MEDICAL CENTER INC

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	103K00000X	Behavior Analyst
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1386282317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUXVIL MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	3800 COLONIAL BLVD STE 101
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-1075
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 COLONIAL BLVD STE 101
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-1075
Country	:	US
Telephone Number	:	239-297-9066
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. YANNY MURSULI
Credential	:
Telephone Number	:	239-297-9066

Provider Enumeration Date	:	12/20/2019
Last Update Date	:	12/26/2019

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Directions to “LUXVIL MEDICAL CENTER INC ” Practice Location

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