Organization
LEE MEMORIAL HEALTH SYSTEM
Active
Other names
LCH - GOLISANO PEDS BH - QUALITY LIFE CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN BOREN (CREDENTIALING SPECIALIST)
(239) 424-1479
Entity
Organization
Contact information
Practice address
3210 DR MARTIN LUTHER KING BLVD, FORT MYERS, FL 33916-2016
(239) 343-6050
(239) 343-6051
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-6050
(239) 343-6051
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
05/23/2024
Last updated
05/23/2024
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