| Lch - Pediatric Ent | |
|
16410 Healthpark Commons Dr Fort Myers FL 33908-9621 | |
| (239) 343-7474 | |
| (239) 343-4190 |
| Full Name | Lch - Pediatric Ent |
|---|---|
| Speciality | Clinic/Center |
| Location | 16410 Healthpark Commons Dr, Fort Myers, Florida |
| Authorized Official Name and Position | James Fores (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 2394241479 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lch - Pediatric Ent Po Box 2147 Fort Myers FL 33902-2147 Ph: (239) 424-1449 | Lch - Pediatric Ent 16410 Healthpark Commons Dr Fort Myers FL 33908-9621 Ph: (239) 343-7474 |
| NPI Number | 1548840838 |
|---|---|
| Provider Enumeration Date | 04/10/2021 |
| Last Update Date | 12/13/2023 |
| Medicare PECOS PAC ID | 8729996608 |
|---|---|
| Medicare Enrollment ID | O20210519000104 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548840838 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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