Organization
LEE MEMORIAL HEALTH SYSTEM
Active
Other names
LCH-Pediatric Nephrology
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 102, FORT MYERS, FL 33908-3838
(239) 343-9890
(239) 343-9898
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-9890
(239) 343-9898
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
04/27/2021
Last updated
04/27/2021
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