Provider Demographics
NPI:1992048946
Name:PREMIER HOSPITALISTS OF SOUTHWEST FLORIDA LLC
Entity type:Organization
Organization Name:PREMIER HOSPITALISTS OF SOUTHWEST FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-723-3569
Mailing Address - Street 1:8761 PIAZZA DEL LAGO CIR
Mailing Address - Street 2:#103
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-8349
Mailing Address - Country:US
Mailing Address - Phone:864-723-3569
Mailing Address - Fax:
Practice Address - Street 1:18101 LAGOS WAY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-2764
Practice Address - Country:US
Practice Address - Phone:864-723-3569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty