Provider Demographics
NPI:1417346388
Name:HOUSECALLS MD SWFL, LLC
Entity Type:Organization
Organization Name:HOUSECALLS MD SWFL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HERMINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-410-3894
Mailing Address - Street 1:2656 BLUE CYPRESS LAKE CT
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-2912
Mailing Address - Country:US
Mailing Address - Phone:239-410-3894
Mailing Address - Fax:239-772-0267
Practice Address - Street 1:2656 BLUE CYPRESS LAKE CT
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2912
Practice Address - Country:US
Practice Address - Phone:239-410-3894
Practice Address - Fax:239-772-0267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty