Provider Demographics
NPI:1154396372
Name:ISLAND COAST PRIMARY CARE PROJECT, INC.
Entity type:Organization
Organization Name:ISLAND COAST PRIMARY CARE PROJECT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:239-433-6760
Mailing Address - Street 1:9800 S HEALTHPARK DR
Mailing Address - Street 2:# 410
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-7603
Mailing Address - Country:US
Mailing Address - Phone:239-433-6760
Mailing Address - Fax:239-433-6766
Practice Address - Street 1:9800 S HEALTHPARK DR
Practice Address - Street 2:# 410
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-7603
Practice Address - Country:US
Practice Address - Phone:239-433-6760
Practice Address - Fax:239-433-6766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care