| Lch- Peds Page Field | |
|
4751 S Cleveland Ave Fort Myers FL 33907-1317 | |
| (239) 343-9888 | |
| (239) 343-9968 |
| Full Name | Lch- Peds Page Field |
|---|---|
| Speciality | Clinic/Center |
| Location | 4751 S Cleveland Ave, Fort Myers, Florida |
| Authorized Official Name and Position | Benjamin Spence (CFO) |
| Authorized Official Contact | 2393436014 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lch- Peds Page Field Po Box 2147 Fort Myers FL 33902-2147 Ph: (239) 424-1500 | Lch- Peds Page Field 4751 S Cleveland Ave Fort Myers FL 33907-1317 Ph: (239) 343-9888 |
| NPI Number | 1013559343 |
|---|---|
| Provider Enumeration Date | 10/08/2019 |
| Last Update Date | 02/23/2024 |
| Medicare PECOS PAC ID | 8729996608 |
|---|---|
| Medicare Enrollment ID | O20191030000909 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013559343 | NPI | - | NPPES |
| 014789114 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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