Provider Demographics
NPI:1407230659
Name:PHYSICIANS FOR QUALITY HEALTHCARE,INC
Entity Type:Organization
Organization Name:PHYSICIANS FOR QUALITY HEALTHCARE,INC
Other - Org Name:PHYSICIANS REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GHANEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-768-6396
Mailing Address - Street 1:6150 DIAMOND CENTRE CT BLDG 100
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4367
Mailing Address - Country:US
Mailing Address - Phone:239-768-6396
Mailing Address - Fax:
Practice Address - Street 1:733 HIGHWAY 466
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-6340
Practice Address - Country:US
Practice Address - Phone:239-768-6396
Practice Address - Fax:239-204-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76719208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFL764BMedicare UPIN
FLFL 764AMedicare UPIN