Provider Demographics
NPI:1962663211
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:
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:239-226-4650
Practice Address - Street 1:4300 KINGS HWY
Practice Address - Street 2:SUITE 500
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2917
Practice Address - Country:US
Practice Address - Phone:239-344-2325
Practice Address - Fax:941-764-6176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029570112Medicaid
FL056887208Medicaid
FL99409Medicare PIN
FL029570112Medicaid