Provider Demographics
NPI:1588812945
Name:FT. MYERS WOMEN'S HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:FT. MYERS WOMEN'S HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AND CONTRACT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARISELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARENGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-442-0445
Mailing Address - Street 1:2106 DREW ST
Mailing Address - Street 2:STE 103
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3238
Mailing Address - Country:US
Mailing Address - Phone:727-442-0445
Mailing Address - Fax:727-447-3797
Practice Address - Street 1:3900 BROADWAY
Practice Address - Street 2:BLDG C
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8193
Practice Address - Country:US
Practice Address - Phone:239-936-4497
Practice Address - Fax:941-936-0161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL828207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty