Provider Demographics
NPI:1184708935
Name:SPECIALISTS IN PRIMARY HEALTHCARE INC
Entity type:Organization
Organization Name:SPECIALISTS IN PRIMARY HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TEJVIR
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHADHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-278-0330
Mailing Address - Street 1:5030 MASON CORBIN CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4548
Mailing Address - Country:US
Mailing Address - Phone:239-278-0330
Mailing Address - Fax:239-278-1348
Practice Address - Street 1:5030 MASON CORBIN CT
Practice Address - Street 2:SUITE A
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4541
Practice Address - Country:US
Practice Address - Phone:239-278-0330
Practice Address - Fax:239-278-1348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370862400Medicaid
FL370862400Medicaid