Fort Myers Family Medicine LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS0005720 Issued in FL

Legal business name

FORT MYERS FAMILY MEDICINE LLC

Practice address

15661 San Carlos Blvd
Suite 2
Fort Myers, FL 33908

Phone

(239) 433-4014

Fax

(239) 481-6247

NPI assigned

Sep 14, 2006

Organization subpart

Yes

Parent organization

FORT MYERS FAMILY MEDICINE PAAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Hursel Lee Adkins Jr., D.O

Title

Executive Managing Director

Phone

(239) 433-4014

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• FORT MYERS FAMILY MEDICINE PA Former legal business name

Part of

H Lee Adkins DO C MD PA

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1255436143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15661 SAN CARLOS BLVD",
            "address_2": "SUITE 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339082797",
            "telephone_number": "239-433-4014",
            "fax_number": "239-481-6247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15661 SAN CARLOS BLVD",
            "address_2": "SUITE 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "33908",
            "telephone_number": "239-433-4014",
            "fax_number": "239-481-6247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT MYERS FAMILY MEDICINE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FORT MYERS FAMILY MEDICINE PA",
        "enumeration_date": "2006-09-14",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "ADKINS",
        "authorized_official_first_name": "HURSEL",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "EXECUTIVE MANAGING DIRECTOR",
        "authorized_official_telephone_number": "239-433-4014",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.O"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS0005720",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "268237100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "K1484",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FORT MYERS FAMILY MEDICINE PA",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "FORT MYERS FAMILY MEDICINE PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Family Medicine Physician in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.