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)

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	681187	OTHER	FL	MEDICARE

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

General Provider Information

NPI Number	:	1922778224
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	:	32891-0001
Country	:	US
Telephone Number	:	239-278-3600
Fax Number	:	239-479-5122

Provider Business Practice Location Address
First Line	:	535 PINE ISLAND RD STE M
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-3700
Country	:	US
Telephone Number	:	239-334-2510
Fax Number	:

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

Provider Enumeration Date	:	09/17/2021
Last Update Date	:	06/21/2022

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Directions to “FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC. ” Practice Location

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