Provider Demographics
NPI:1982353934
Name:IMC FL
Entity Type:Organization
Organization Name:IMC FL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VAISHALI
Authorized Official - Middle Name:NENE
Authorized Official - Last Name:GEIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-725-3190
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22183-0309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10058 GULF CENTER DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8961
Practice Address - Country:US
Practice Address - Phone:833-493-4325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-18
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service