Provider Demographics
NPI:1861687618
Name:PILOT HEALTHCARE P.L.
Entity Type:Organization
Organization Name:PILOT HEALTHCARE P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BRIDEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-992-7822
Mailing Address - Street 1:20791 THREE OAKS PKWY
Mailing Address - Street 2:#1209
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33929-3670
Mailing Address - Country:US
Mailing Address - Phone:239-992-7822
Mailing Address - Fax:239-947-5687
Practice Address - Street 1:3501 HEALTH CENTER BLVD
Practice Address - Street 2:#2230
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-8127
Practice Address - Country:US
Practice Address - Phone:239-992-7822
Practice Address - Fax:239-947-5687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51156261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB50458Medicare UPIN