Provider Demographics
NPI:1598850620
Name:S.W. FLORIDA PROSTHETIC CLINIC, INC.
Entity Type:Organization
Organization Name:S.W. FLORIDA PROSTHETIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED ANAPLASTOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:T
Authorized Official - Last Name:ANERINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-936-0033
Mailing Address - Street 1:13691 METRO PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FT. MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912
Mailing Address - Country:US
Mailing Address - Phone:239-936-0033
Mailing Address - Fax:239-936-0047
Practice Address - Street 1:13691 METRO PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:FT. MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912
Practice Address - Country:US
Practice Address - Phone:239-936-0033
Practice Address - Fax:239-936-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM6012OtherEYE, EAR, NOSE PROSTHETIC
FL0643280001Medicare ID - Type UnspecifiedEYE, EAR, NOSE PROSTHETIC