Provider Demographics
NPI:1528353554
Name:PHYSICIANS FOR QUALITY HEALTHCARE, INC.
Entity type:Organization
Organization Name:PHYSICIANS FOR QUALITY HEALTHCARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GHANEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-768-6396
Mailing Address - Street 1:6150 DIAMOND CENTRE CT
Mailing Address - Street 2:BLDG 100
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912
Mailing Address - Country:US
Mailing Address - Phone:239-768-6396
Mailing Address - Fax:
Practice Address - Street 1:6150 DIAMOND CENTRE CT
Practice Address - Street 2:BUILDING 100
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4368
Practice Address - Country:US
Practice Address - Phone:239-768-6396
Practice Address - Fax:239-204-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10413261QM1300X
261QP2000X, 332B00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6607980001Medicare NSC
FL6607980002Medicare NSC