NPIMap

Organization Active NPI

Injury Treatment Center of Fort Myers Inc

  • General Practice Physician
  • Fort Myers, FL
National Provider Identifier
1376664565
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
HCC6084 Issued in FL
Legal business name
INJURY TREATMENT CENTER OF FORT MYERS INC
Practice address
8595 College Pkwy
Suite A2
Fort Myers, FL 33919-5191
Phone
(239) 489-2290
Fax
(239) 482-6028
NPI assigned
Apr 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Evan Sade
Title
Consultant
Phone
(954) 817-9402

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X HCC6084 FL Primary

Addresses

Primary practice location

8595 College Pkwy
Suite A2
Fort Myers, FL 33919-5191

Mailing address

2295 NW Corporate Blvd
Suite 140
Boca Raton, FL 33431-7373
Phone (561) 241-1971

Other identifiers 1

IdentifierTypeStateIssuer
00802OtherFLBLUE SHIELD NUMBER

Other names 1

  • Choice Medical Center Doing business as

National Provider Directory

National Provider Directory

Locations

8595 College Pkwy
#A2
Fort Myers, FL 33919
Phone (239) 489-2290

8595 College Pkwy
Ste A2
Fort Myers, FL 33919
Phone (239) 489-2290

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1376664565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2295 NW CORPORATE BLVD",
            "address_2": "SUITE 140",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334317373",
            "telephone_number": "561-241-1971",
            "fax_number": "561-241-3969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8595 COLLEGE PKWY",
            "address_2": "SUITE A2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339195191",
            "telephone_number": "239-489-2290",
            "fax_number": "239-482-6028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INJURY TREATMENT CENTER OF FORT MYERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "SADE",
        "authorized_official_first_name": "EVAN",
        "authorized_official_title_or_position": "CONSULTANT",
        "authorized_official_telephone_number": "954-817-9402"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "FL",
            "license": "HCC6084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD NUMBER",
            "identifier": "00802",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Choice Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.