Organization
LEE MEMORIAL HEALTH SYSTEM
Active
Other names
LCH-ADDICITION MEDICINE NB
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH NIEBERGALL (CREDENTIALING SPECIALIST)
(239) 424-1446
Entity
Organization
Contact information
Practice address
12550 NEW BRITTANY BLVD STE 201, FORT MYERS, FL 33907-3655
(239) 343-9190
(239) 343-9193
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-9190
(239) 343-9193
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
06/18/2020
Last updated
06/18/2020
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