NPIMap

Organization Active NPI

Southwest Florida Mobile Wound Care LLC

  • Family Nurse Practitioner
  • Estero, FL
National Provider Identifier
1487336863
Registry record updated Dec 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
SOUTHWEST FLORIDA MOBILE WOUND CARE LLC
Practice address
21208 Waymouth Run
Estero, FL 33928-3243
Phone
(401) 256-9997
Fax
(239) 361-2780
NPI assigned
Aug 3, 2023
Last updated
Dec 29, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2023

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

Authorized official

Name
Mekaael Mahmoud, OTR/LNPI 1568046415
Title
Managing Member
Phone
(239) 214-9842

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Wound Care Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WW0000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

21208 Waymouth Run
Estero, FL 33928-3243

Mailing address

21208 Waymouth Run
Estero, FL 33928-3243
Phone (401) 256-9997

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231018002261 FL Part B Supplier - Clinic/Group Practice 4587019021 Receives reassigned benefits from 14 practitioners
Practice locations: Fort Myers, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1691020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703808000000",
    "number": "1487336863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21208 WAYMOUTH RUN",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "339283243",
            "telephone_number": "401-256-9997",
            "fax_number": "239-361-2780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21208 WAYMOUTH RUN",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "339283243",
            "telephone_number": "401-256-9997",
            "fax_number": "239-361-2780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST FLORIDA MOBILE WOUND CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-03",
        "last_updated": "2023-12-29",
        "certification_date": "2023-12-29",
        "status": "A",
        "authorized_official_last_name": "MAHMOUD",
        "authorized_official_first_name": "MEKAAEL",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "239-214-9842",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "163WW0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Estero, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.