MEDICARE: FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA 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	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669634903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA INC

Provider Business Mailing Address
First Line	:	PO BOX 919771
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-9771
Country	:	US
Telephone Number	:	239-278-3600
Fax Number	:	239-226-4650

Provider Business Practice Location Address
First Line	:	4040 PALM BEACH BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-3470
Country	:	US
Telephone Number	:	239-344-2304
Fax Number	:	239-693-7494

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	FRANK MAZZEO JR.
Credential	:
Telephone Number	:	239-278-3600

Provider Enumeration Date	:	06/27/2008
Last Update Date	:	05/18/2022

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