| Chs-fsu Primary Care | |
|
1441 Heritage Blvd Immokalee FL 34142-2260 | |
| (239) 658-3000 | |
| Not Available |
| Full Name | Chs-fsu Primary Care |
|---|---|
| Speciality | Clinic/Center |
| Location | 1441 Heritage Blvd, Immokalee, Florida |
| Authorized Official Name and Position | Mike Ellis (CEO) |
| Authorized Official Contact | 2396583707 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chs-fsu Primary Care 1454 Madison Ave W Immokalee FL 34142-2200 Ph: (239) 658-3707 | Chs-fsu Primary Care 1441 Heritage Blvd Immokalee FL 34142-2260 Ph: (239) 658-3000 |
| NPI Number | 1194919993 |
|---|---|
| Provider Enumeration Date | 09/05/2007 |
| Last Update Date | 01/09/2019 |
| Medicare PECOS PAC ID | 4183521925 |
|---|---|
| Medicare Enrollment ID | O20090106000632 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194919993 | NPI | - | NPPES |
| 683955012 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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