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  7. NPI Record 1124013149

SOUTH GULF COAST EMERGENCY PHYSICIANS PA
Complete NPI Record 1124013149
Emergency Medicine in Ft Myers, FL

NPI Status: Active since September 15, 2005

Contact Information

13681 DOCTORS WAY
FT MYERS, FL
ZIP 33912
Phone: (239) 768-8611

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider First Line Business Practice Location Address
  11. Provider Business Practice Location Address City Name
  12. Provider Business Practice Location Address State Name
  13. Provider Business Practice Location Address Postal Code
  14. Provider Business Practice Location Address Country Code If outside U S
  15. Provider Business Practice Location Address Telephone Number
  16. Provider Enumeration Date
  17. Last Update Date
  18. Authorized Official Last Name
  19. Authorized Official First Name
  20. Authorized Official Title or Position
  21. Authorized Official Telephone Number
  22. Healthcare Provider Taxonomy Code 1
  23. Healthcare Provider Primary Taxonomy Switch 1
  24. Other Provider Identifier 1
  25. Other Provider Identifier Type Code 1
  26. Other Provider Identifier State 1
  27. Other Provider Identifier 2
  28. Other Provider Identifier Type Code 2
  29. Other Provider Identifier State 2
  30. Other Provider Identifier Issuer 2
  31. Other Provider Identifier 3
  32. Other Provider Identifier Type Code 3
  33. Other Provider Identifier State 3
  34. Other Provider Identifier Issuer 3
  35. Other Provider Identifier 4
  36. Other Provider Identifier Type Code 4
  37. Other Provider Identifier State 4
  38. Other Provider Identifier Issuer 4
  39. Is Organization Subpart
  40. Authorized Official Name Prefix Text
  41. Authorized Official Credential Text
  42. Healthcare Provider Taxonomy Group 1

Complete NPI Dataset

This page represents the complete record for NPI 1124013149. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1124013149
The first name of the provider, if the provider is an individual.
Entity Type Code: 2
The middle name of the provider, if the provider is an individual.
Employer Identification Number EIN: UNAVAIL
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: P.O. BOX 634748
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: CINCINNATI
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address State Name: OH
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address Postal Code: 452630001
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Country Code If outside U S : US
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider First Line Business Practice Location Address: 13681 DOCTORS WAY
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Practice Location Address City Name: FT MYERS
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: FL
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 339124300
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 2397688611
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 9/15/2005
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 3/4/2009
The date that a record was last updated or changed.
Authorized Official Last Name: SCHAAR
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: THOMAS
The first name of the authorized official.
Authorized Official Title or Position: PRESIDENT
The title or position of the authorized official.
Authorized Official Telephone Number: 8662669879
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 207P00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Other Provider Identifier 1: 064524900
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: FL
Other Provider Identifier 2: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: FL
Other Provider Identifier Issuer 2: CHAMPUS GROUP
Other Provider Identifier 3: 00240
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: FL
Other Provider Identifier Issuer 3: BCBS GROUP
Other Provider Identifier 4: CC9721
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: FL
Other Provider Identifier Issuer 4: RR MCR GROUP
Is Organization Subpart: N
Authorized Official Name Prefix Text: DR.
Authorized Official Credential Text: MD
Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP