Provider Demographics
NPI:1760164800
Name:FORT MYERS PRIMARY CARE AND WELLNESS
Entity Type:Organization
Organization Name:FORT MYERS PRIMARY CARE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:SABHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-922-0909
Mailing Address - Street 1:14131 METROPOLIS AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4455
Mailing Address - Country:US
Mailing Address - Phone:239-922-0909
Mailing Address - Fax:
Practice Address - Street 1:14131 METROPOLIS AVE STE 105
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4455
Practice Address - Country:US
Practice Address - Phone:239-922-0909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty