Provider Demographics
NPI:1386958809
Name:USBD HOSPITALISTS & CONSULTANTS INC
Entity type:Organization
Organization Name:USBD HOSPITALISTS & CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARUQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:239-225-1778
Mailing Address - Street 1:14015 DANPARK LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-6854
Mailing Address - Country:US
Mailing Address - Phone:239-225-1778
Mailing Address - Fax:239-603-7264
Practice Address - Street 1:14015 DANPARK LOOP
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-6854
Practice Address - Country:US
Practice Address - Phone:239-225-1778
Practice Address - Fax:239-603-7264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95171314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15587OtherTIN
FL280098500Medicaid
FL1386744639OtherNPI
FLAD052YOtherPTAN
FLK8680OtherPTAN
FL1386744639OtherNPI
FL280098500Medicaid