Provider Demographics
NPI:1356853154
Name:FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.
Entity Type:Organization
Organization Name:FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.
Other - Org Name:RONALD MCDONALD CARE MOBILE
Other - Org Type:Other Name
Authorized Official - Title/Position:VP/CMO
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINONEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-278-3600
Mailing Address - Street 1:PO BOX 919771
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9771
Mailing Address - Country:US
Mailing Address - Phone:239-278-3600
Mailing Address - Fax:239-226-4650
Practice Address - Street 1:1926 VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-3414
Practice Address - Country:US
Practice Address - Phone:239-278-3600
Practice Address - Fax:239-226-4650
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-02
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)