Organization
PROVIDENCE FAMILY LIFE CENTER CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA KOHLER (BILLING SPECIALIST)
(813) 720-7694
Entity
Organization
Contact information
Practice address
3592 BROADWAY STE 100, FORT MYERS, FL 33901-8056
(239) 676-3159
(239) 519-9202
Mailing address
3049 CLEVELAND AVE, FORT MYERS, FL 33901-7041
(239) 676-3159
(888) 519-9202
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
07/18/2022
Last updated
07/18/2022
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