Provider Demographics
NPI:1407514904
Name:SANTE PLUS MEDICAL CENTER
Entity Type:Organization
Organization Name:SANTE PLUS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICOT
Authorized Official - Middle Name:
Authorized Official - Last Name:JEANSIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-603-2377
Mailing Address - Street 1:3822 BROADWAY STE A
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8148
Mailing Address - Country:US
Mailing Address - Phone:239-603-2377
Mailing Address - Fax:561-293-7717
Practice Address - Street 1:1502 LAKE TRAFFORD RD
Practice Address - Street 2:
Practice Address - City:IMMOKALEE
Practice Address - State:FL
Practice Address - Zip Code:34142-2618
Practice Address - Country:US
Practice Address - Phone:239-900-9170
Practice Address - Fax:239-603-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center