| Lee Memorial Health System | |
|
2525 Harbor Blvd Ste 204 Port Charlotte FL 33952-5342 | |
| (941) 629-2922 | |
| (941) 629-1311 |
| Full Name | Lee Memorial Health System |
|---|---|
| Speciality | Clinic/Center |
| Location | 2525 Harbor Blvd Ste 204, Port Charlotte, Florida |
| Authorized Official Name and Position | Joseph Niebergall (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 2394241446 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lee Memorial Health System Po Box 2147 Fort Myers FL 33902-2147 Ph: (941) 629-2922 | Lee Memorial Health System 2525 Harbor Blvd Ste 204 Port Charlotte FL 33952-5342 Ph: (941) 629-2922 |
| NPI Number | 1902425028 |
|---|---|
| Provider Enumeration Date | 04/09/2020 |
| Last Update Date | 04/09/2020 |
| Medicare PECOS PAC ID | 8729996608 |
|---|---|
| Medicare Enrollment ID | O20200518002983 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902425028 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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