| Lch- Peds Lhcp | |
|
23450 Via Coconut Pt Estero FL 34135-1877 | |
| (239) 468-0150 | |
| (239) 343-4056 |
| Full Name | Lch- Peds Lhcp |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 23450 Via Coconut Pt, Estero, Florida |
| Authorized Official Name and Position | Joseph Niebergall (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 2394241446 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lch- Peds Lhcp Po Box 2147 Fort Myers FL 33902-2147 Ph: (239) 468-0150 | Lch- Peds Lhcp 23450 Via Coconut Pt Estero FL 34135-1877 Ph: (239) 468-0150 |
| NPI Number | 1619512803 |
|---|---|
| Provider Enumeration Date | 11/12/2019 |
| Last Update Date | 03/27/2020 |
| Certification Date | 03/27/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619512803 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
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