Organization
LEE MEMORIAL HEALTH SYSTEM
Active
Other names
LCH-GOLISANO PEDS PC BAYSHORE
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 120, PORT CHARLOTTE, FL 33980-2005
(239) 343-9888
(239) 343-4266
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-9888
(239) 343-4266
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
05/31/2024
Last updated
05/31/2024
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