| Tlc Medical Center Llc | |
|
2040 Collier Ave Suite A Fort Myers FL 33901-8124 | |
| (239) 645-3131 | |
| Not Available |
| Full Name | Tlc Medical Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2040 Collier Ave, Fort Myers, Florida |
| Authorized Official Name and Position | Jacques Herve Desir (PRESIDENT) |
| Authorized Official Contact | 2396453131 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tlc Medical Center Llc 1411 Se 33rd St Cape Coral FL 33904-4275 Ph: (239) 645-3131 | Tlc Medical Center Llc 2040 Collier Ave Suite A Fort Myers FL 33901-8124 Ph: (239) 645-3131 |
| NPI Number | 1295102598 |
|---|---|
| Provider Enumeration Date | 08/22/2015 |
| Last Update Date | 08/22/2015 |
| Medicare PECOS PAC ID | 6608173851 |
|---|---|
| Medicare Enrollment ID | O20160401001693 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295102598 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Jacques Desir |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073829966 PECOS PAC ID: 6305032624 Enrollment ID: I20101130000072 |
| Provider Name | Viergela D Joseph |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649742628 PECOS PAC ID: 4789926825 Enrollment ID: I20190422001006 |
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