Provider Demographics
NPI:1366653081
Name:STEPHEN F. SCHOLLE MD PA
Entity Type:Organization
Organization Name:STEPHEN F. SCHOLLE MD PA
Other - Org Name:BEACH FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SCHOLLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-765-0007
Mailing Address - Street 1:PO BOX 6970
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33932-6970
Mailing Address - Country:US
Mailing Address - Phone:239-765-0007
Mailing Address - Fax:239-765-0247
Practice Address - Street 1:1661 ESTERO BLVD STE 1
Practice Address - Street 2:
Practice Address - City:FORT MYERS BEACH
Practice Address - State:FL
Practice Address - Zip Code:33931-2846
Practice Address - Country:US
Practice Address - Phone:239-765-0007
Practice Address - Fax:239-765-0247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0033695261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL90071995OtherMEDICARE RAIL ROAD
FLK0976Medicare ID - Type UnspecifiedMEDICARE GROUP
FL90071995OtherMEDICARE RAIL ROAD
FLC36315Medicare UPIN