Provider Demographics
NPI:1932503851
Name:PHYSICIANS FOR QUALITY HEALTHCARE,INC
Entity Type:Organization
Organization Name:PHYSICIANS FOR QUALITY HEALTHCARE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GHANEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-768-6396
Mailing Address - Street 1:6150 DIAMOND CENTRE CT BLDG 100
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4367
Mailing Address - Country:US
Mailing Address - Phone:239-768-6396
Mailing Address - Fax:239-204-3000
Practice Address - Street 1:413 DEL PRADO BLVD S STE 201
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-5703
Practice Address - Country:US
Practice Address - Phone:239-768-6396
Practice Address - Fax:239-204-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC9815261QM1300X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFL764AMedicare PIN