Provider Demographics
NPI:1891929477
Name:LUXOR INDUSTRIES-PHYSICIANS GROUP NORTH FORT MYERS FL DIVISION LLC
Entity Type:Organization
Organization Name:LUXOR INDUSTRIES-PHYSICIANS GROUP NORTH FORT MYERS FL DIVISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL LYNN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-674-8079
Mailing Address - Street 1:1890 N. TAMIAMI TRAIL
Mailing Address - Street 2:UNIT F
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1890 N TAMIAMI TRL
Practice Address - Street 2:UNIT F
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-3340
Practice Address - Country:US
Practice Address - Phone:863-244-9585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization