Provider Demographics
NPI:1619341369
Name:PANIRA HEALTHCARE CLINIC, INC,
Entity Type:Organization
Organization Name:PANIRA HEALTHCARE CLINIC, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:EGGER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:239-529-5580
Mailing Address - Street 1:4975 TAMIAMI TRL E
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-4131
Mailing Address - Country:US
Mailing Address - Phone:239-529-5580
Mailing Address - Fax:239-280-0264
Practice Address - Street 1:4975 TAMIAMI TRL E
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-4131
Practice Address - Country:US
Practice Address - Phone:239-529-5580
Practice Address - Fax:239-280-0264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 207RI0200X, 261QU0200X
FLHCC12032261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021195500Medicaid