Provider Demographics
NPI:1790898666
Name:ACCESS MEDICAL SOUTH, LC
Entity Type:Organization
Organization Name:ACCESS MEDICAL SOUTH, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-343-6014
Mailing Address - Street 1:12681 CREEKSIDE LN STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3359
Mailing Address - Country:US
Mailing Address - Phone:239-343-8290
Mailing Address - Fax:239-343-8291
Practice Address - Street 1:9369 LAREDO AVE STE 170
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-4632
Practice Address - Country:US
Practice Address - Phone:239-343-8290
Practice Address - Fax:239-343-8291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLATN675402Medicaid
FL021547300Medicaid