Provider Demographics
NPI:1154304087
Name:GASTROENTEROLOGY ASSOCIATES OF SOUTHWEST FLORIDA LLC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF SOUTHWEST FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NEEKAYTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-275-8882
Mailing Address - Street 1:4790 BARKLEY CIR
Mailing Address - Street 2:BUILDING A
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7543
Mailing Address - Country:US
Mailing Address - Phone:239-275-8882
Mailing Address - Fax:239-275-6304
Practice Address - Street 1:4790 BARKLEY CIR
Practice Address - Street 2:BUILDING A
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7543
Practice Address - Country:US
Practice Address - Phone:239-275-8882
Practice Address - Fax:239-275-6304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370377100Medicaid
FLCL0683OtherRAILROAD MEDICARE
FL2400027OtherGHI
FL8720453OtherAETNA
FL39058OtherBCBS
FL370377100Medicaid