Provider Demographics
NPI:1669062691
Name:SIA MEDICAL CENTER CORP
Entity type:Organization
Organization Name:SIA MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCULL-JUSTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-833-9690
Mailing Address - Street 1:12811 KENWOOD LN STE 105
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5643
Mailing Address - Country:US
Mailing Address - Phone:305-833-9690
Mailing Address - Fax:
Practice Address - Street 1:12811 KENWOOD LN STE 105
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5643
Practice Address - Country:US
Practice Address - Phone:305-833-9690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-23
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty