Organization
FLORIDA COMMUNITY HEALTH CENTERS INC
Active
Other names
Lakeshore Pediatrics Annex
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL F GERVASI D.O. (PRESIDENT & CEO)
(561) 844-9443
Entity
Organization
Contact information
Practice address
4450 S TIFFANY DR, WEST PALM BEACH, FL 33407-3241
(561) 844-9443
(561) 844-1013
Mailing address
4450 S TIFFANY DR, WEST PALM BEACH, FL 33407-3241
(561) 844-9443
(561) 844-1013
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029574414
—
FL
05
—
029574415
—
FL
Enumeration date
05/10/2006
Last updated
09/06/2011
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