Provider Demographics
NPI:1386786838
Name:PEDIATRIC ORTHOPEDICS OF SOUTHWEST FLORIDA
Entity type:Organization
Organization Name:PEDIATRIC ORTHOPEDICS OF SOUTHWEST FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-432-5100
Mailing Address - Street 1:15880 SUMMERLIN RD
Mailing Address - Street 2:STE 300 PMB 322
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-9612
Mailing Address - Country:US
Mailing Address - Phone:239-432-5100
Mailing Address - Fax:239-432-5135
Practice Address - Street 1:15821 HOLLYFERN COURT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908
Practice Address - Country:US
Practice Address - Phone:239-432-5100
Practice Address - Fax:239-432-5135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4993207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1245244995OtherDR. JOHN CHURCHILL NPI
FL1043224520OtherDR. DENNIS CARDONE NPI
FL1518971225OtherDR. F. BRETT SHANNON NPI
FLF86462Medicare UPIN
FL1245244995OtherDR. JOHN CHURCHILL NPI
FLF44611Medicare UPIN