Basic Information
| Provider Information | |||||||||
| NPI: | 1588659502 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHWEST FLORIDA EMERGENCY PHYSICIANS, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 634633 | ||||||||
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| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452630001 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 13681 DOCTORS WAY | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339124300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2397688611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 03/02/2009 | ||||||||
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| AuthorizedOfficialLastName: | SCHAAR | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8882669879 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 064433100 | 05 | FL | MEDICAID | 00215 | 01 | FL | BCBS GROUP | OTHER | CB5038 | 01 | FL | RR MCR GROUP | OTHER |