SOUTHWEST FLORIDA FERTILITY CENTER PA; NPI #1588749618

Contact Information

SOUTHWEST FLORIDA FERTILITY CENTER PA

15730 NEW HAMPSHIRE CT
SUITE 101
FORT MYERS, FL 33908

Phone: 239-561-3430
Fax: 239-561-6980
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Reproductive Endocrinology	207VE0102X	16	Physician/Obstetrics & Gynecology

Indicates primary specialty

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NPI Profile & details for SOUTHWEST FLORIDA FERTILITY CENTER PA

NPI # 1588749618

LBN Legal business name SOUTHWEST FLORIDA FERTILITY CENTER PA

Authorized official JACOB GLOCK - (PRESIDENT)

Entity Organization

Organization subpart ¹ No

Enumeration date 10/26/2006

Last updated 01/12/2009 - About 17 years ago

Identifiers

FL	License #	ME0057264
FL	Medicaid	379285400
FL	Other	ME0057264	FLORIDA STATE LICENSE

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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