Provider Demographics
NPI:1619283033
Name:CHARLOTTE COUNTY MEDICAL SOLUTIONS INC
Entity Type:Organization
Organization Name:CHARLOTTE COUNTY MEDICAL SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILIYA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-274-3004
Mailing Address - Street 1:3822 BROADWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8148
Mailing Address - Country:US
Mailing Address - Phone:239-274-3004
Mailing Address - Fax:239-274-6007
Practice Address - Street 1:3191 HARBOR BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6755
Practice Address - Country:US
Practice Address - Phone:941-206-2630
Practice Address - Fax:941-206-2633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMC56208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty