Provider Demographics
NPI:1891010393
Name:FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA INC
Entity Type:Organization
Organization Name:FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZEO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-278-3600
Mailing Address - Street 1:PO BOX 919771
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9771
Mailing Address - Country:US
Mailing Address - Phone:239-278-3600
Mailing Address - Fax:239-278-3857
Practice Address - Street 1:11100 SUMMER RIDGE LANE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-0000
Practice Address - Country:US
Practice Address - Phone:239-344-2389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029570108Medicaid
FL029570109Medicaid
FL99409OtherBLUE CROSS BLUE SHIELD
FL029570109Medicaid