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Organization

LEE MEMORIAL HEALTH SYSTEM

Active
Other names
LCH-PEDIATRIC NEUROLOGICAL HEALTH
Organization subpart
No

Provider details

NPI number
Authorized official
JOSEPH NIEBERGALL (CREDENTIALING SPECIALIST)
(239) 424-1446
Entity
Organization

Contact information

Practice address
15901 BASS RD STE 108, FORT MYERS, FL 33908-3838
(239) 343-6050
(239) 343-6051
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 424-1449
(239) 424-1423

Taxonomy

Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary

Other

Enumeration date
11/19/2020
Last updated
01/18/2021
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