Provider Demographics
NPI:1407915374
Name:NAPLES INJURY CENTER #2 INC
Entity Type:Organization
Organization Name:NAPLES INJURY CENTER #2 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-902-1200
Mailing Address - Street 1:876 W SUGARLAND HWY
Mailing Address - Street 2:UNIT 1 C
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-2704
Mailing Address - Country:US
Mailing Address - Phone:863-902-1200
Mailing Address - Fax:863-902-1204
Practice Address - Street 1:876 W SUGARLAND HWY
Practice Address - Street 2:UNIT 1 C
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-2704
Practice Address - Country:US
Practice Address - Phone:863-902-1200
Practice Address - Fax:863-902-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6909305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9509Medicare ID - Type Unspecified