Provider Demographics
NPI:1013118041
Name:NEUROPSYCHIATRIC RESEARCH CENTER OF SOUTHWEST FLORIDA LLC
Entity Type:Organization
Organization Name:NEUROPSYCHIATRIC RESEARCH CENTER OF SOUTHWEST FLORIDA LLC
Other - Org Name:NEUROPSYCHIATRIC ASSOCIATES OF SOUTHWEST FLORIDA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-939-7777
Mailing Address - Street 1:14271 METROPOLIS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4302
Mailing Address - Country:US
Mailing Address - Phone:239-939-7777
Mailing Address - Fax:239-936-0036
Practice Address - Street 1:14271 METROPOLIS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4302
Practice Address - Country:US
Practice Address - Phone:239-939-7777
Practice Address - Fax:239-936-0036
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVOLUTION RESEARCH GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-29
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME924472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24900Medicare ID - Type Unspecified