Provider Demographics
NPI:1184900649
Name:SWFL MEN'S HEALTH
Entity type:Organization
Organization Name:SWFL MEN'S HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-349-6583
Mailing Address - Street 1:401 COMMERCIAL CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-1652
Mailing Address - Country:US
Mailing Address - Phone:941-870-2250
Mailing Address - Fax:
Practice Address - Street 1:401 COMMERCIAL CT
Practice Address - Street 2:SUITE D
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1652
Practice Address - Country:US
Practice Address - Phone:941-870-2250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty