Organization
LEE MEMORIAL HEALTH SYSTEM
Active
Other names
GCHSWFL Charlotte County Pediatric Specialty Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
VIVIAN M RODRIGUEZ (CREDENTIALING SPECIALIST)
(239) 424-1452
Entity
Organization
Contact information
Practice address
22655 BAYSHORE RD STE 110, PORT CHARLOTTE, FL 33980-2005
(412) 354-9009
(941) 235-4901
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(941) 235-4900
(941) 235-4901
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
06/11/2024
Last updated
06/11/2024
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