Skilled Nursing Care Medical Group LLC

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

Legal business name

SKILLED NURSING CARE MEDICAL GROUP LLC

Practice address

2335 Aaron St
Port Charlotte, FL 33952-5305

Phone

(855) 670-7400

Fax

(855) 674-7401

NPI assigned

Jul 16, 2014

Organization subpart

No

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

Authorized official

Name

Mr. David Koeninger

Title

Cfo

Phone

(855) 674-7400

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1405468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406851200000",
    "number": "1265849830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3434 HANCOCK BRIDGE PKWY",
            "address_2": "STE 301",
            "city": "NORTH FORT MYERS",
            "state": "FL",
            "postal_code": "339037094",
            "telephone_number": "877-856-3774",
            "fax_number": "239-599-2625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2335 AARON ST",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339525305",
            "telephone_number": "855-670-7400",
            "fax_number": "855-674-7401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKILLED NURSING CARE MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-16",
        "last_updated": "2014-08-01",
        "status": "A",
        "authorized_official_last_name": "KOENINGER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "855-674-7400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Medicine Physician in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• Adult Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2014; 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.