Provider Demographics
NPI:1528379344
Name:RJ3 SWFL
Entity Type:Organization
Organization Name:RJ3 SWFL
Other - Org Name:FIRST CHOICE PAIN CARE CLINIC SWFL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-480-0200
Mailing Address - Street 1:401 COMMERCIAL CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-1652
Mailing Address - Country:US
Mailing Address - Phone:941-480-0200
Mailing Address - Fax:941-485-8404
Practice Address - Street 1:13100 WESTLINKS TER
Practice Address - Street 2:SUITE 12
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8624
Practice Address - Country:US
Practice Address - Phone:239-332-2360
Practice Address - Fax:239-332-0830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8550261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain