Organization
FLORIDA COMMUNITY HEALTH CENTERS INC
Active
Other names
Lakeshore Medical - Adults
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL F GERVASI (PRESIDENT & CEO)
(561) 844-9443
Entity
Organization
Contact information
Practice address
1100 N PARROTT AVE, OKEECHOBEE, FL 34972-2129
(863) 763-7481
(863) 763-5920
Mailing address
5827 CORPORATE WAY, WEST PALM BEACH, FL 33407-2000
(561) 844-9443
(561) 844-1013
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029574406
—
FL
05
—
029574407
—
FL
Enumeration date
05/10/2006
Last updated
06/17/2016
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