Provider Demographics
NPI:1669502704
Name:OLGA FREEMAN MD PA
Entity Type:Organization
Organization Name:OLGA FREEMAN MD PA
Other - Org Name:OLGA FREEMAN, M.D.,P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL BILLING/CODING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-225-7261
Mailing Address - Street 1:13641 METROPOLIS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912
Mailing Address - Country:US
Mailing Address - Phone:239-225-7261
Mailing Address - Fax:239-225-7945
Practice Address - Street 1:13641 METROPOLIS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912
Practice Address - Country:US
Practice Address - Phone:239-225-7261
Practice Address - Fax:239-225-7945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68876261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAC380OtherMEDICARE
FL27750YMedicare PIN
FLAC380OtherMEDICARE