NPIMap

Organization Active NPI

Seminole Tribe of Florida

  • Primary Care Clinic/Center
  • Immokalee, FL
National Provider Identifier
1851662472
Registry record updated Jan 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
SEMINOLE TRIBE OF FLORIDA
Practice address
1120 S. First Street
Immokalee, FL 34142
Phone
(239) 867-3400
Fax
(239) 657-2304
NPI assigned
Jan 13, 2012
Organization subpart
Yes
Parent organization
SEMINOLE TRIBE OF FLORIDAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 13, 2012

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

Authorized official

Name
Connie Whidden, MSW
Title
Health Director Seminole Tribe of F
Phone
(954) 962-2009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1120 S. First Street
Immokalee, FL 34142

Mailing address

1120 S. First Street
Immokalee, FL 34142
Phone (239) 867-3400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210817002167 TX Part B Supplier - Clinic/Group Practice 4082710835 Receives reassigned benefits from 15 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clewiston, FL; Hollywood, FL; Immokalee, FL; Okeechobee, FL

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Seminole Tribe of Florida9 organizations share this tax ID, including this one
Part of
Seminole Tribe of Florida

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1120 S 1st St
Immokalee, FL 34142
Phone (239) 867-3400

Practitioners & affiliated clinicians

Practitioners 1

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": "1326412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326412800000",
    "number": "1851662472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 S. FIRST STREET",
            "city": "IMMOKALEE",
            "state": "FL",
            "postal_code": "34142",
            "telephone_number": "239-867-3400",
            "fax_number": "239-657-2304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 S. FIRST STREET",
            "city": "IMMOKALEE",
            "state": "FL",
            "postal_code": "34142",
            "telephone_number": "239-867-3400",
            "fax_number": "239-657-2304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEMINOLE TRIBE OF FLORIDA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SEMINOLE TRIBE OF FLORIDA",
        "enumeration_date": "2012-01-13",
        "last_updated": "2012-01-13",
        "status": "A",
        "authorized_official_last_name": "WHIDDEN",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_title_or_position": "HEALTH DIRECTOR SEMINOLE TRIBE OF F",
        "authorized_official_telephone_number": "954-962-2009",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Immokalee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2012; 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.