Provider Demographics
NPI:1659445757
Name:EPILEPSY SERVICES OF SOUTHWEST FLORIDA, INC.
Entity Type:Organization
Organization Name:EPILEPSY SERVICES OF SOUTHWEST FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:GERRITY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-953-5988
Mailing Address - Street 1:1900 MAIN ST
Mailing Address - Street 2:SUITE #212
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5991
Mailing Address - Country:US
Mailing Address - Phone:941-953-5988
Mailing Address - Fax:941-366-5890
Practice Address - Street 1:1900 MAIN ST
Practice Address - Street 2:SUITE #212
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-5991
Practice Address - Country:US
Practice Address - Phone:941-953-5988
Practice Address - Fax:941-366-5890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty