Provider Demographics
NPI:1710395744
Name:TMS CENTER OF SOUTHWEST FLORIDA, LLC
Entity Type:Organization
Organization Name:TMS CENTER OF SOUTHWEST FLORIDA, LLC
Other - Org Name:THE TMS CENTER OF SOUTHWEST FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:POLLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-332-4700
Mailing Address - Street 1:6804 PORTO FINO CIR STE 1
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7139
Mailing Address - Country:US
Mailing Address - Phone:239-332-4700
Mailing Address - Fax:888-769-5641
Practice Address - Street 1:6804 PORTO FINO CIR STE 1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7139
Practice Address - Country:US
Practice Address - Phone:239-332-4700
Practice Address - Fax:888-769-5641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLEXEMPT261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health