Provider Demographics
NPI:1245584283
Name:PERSONALIZED HEALTH CARE INC
Entity Type:Organization
Organization Name:PERSONALIZED HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:TOPPING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-625-6555
Mailing Address - Street 1:1315 FLORIDA AVENUE
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7707
Mailing Address - Country:US
Mailing Address - Phone:239-694-6246
Mailing Address - Fax:239-344-3333
Practice Address - Street 1:1315 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7707
Practice Address - Country:US
Practice Address - Phone:239-694-6246
Practice Address - Fax:239-344-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88414208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2369899400Medicare PIN