NPIMap

Organization Active NPI

Lee Memorial Health System

  • Federally Qualified Health Center (FQHC)
  • Port Charlotte, FL
National Provider Identifier
1164051405
Registry record updated Apr 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LEE MEMORIAL HEALTH SYSTEM
Practice address
2484 Caring Way Unit F
Port Charlotte, FL 33952-5306
Phone
(941) 625-1999
Fax
(941) 625-4600
NPI assigned
Apr 8, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joseph Niebergall
Title
Credentialing Specialist
Phone
(239) 424-1446

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2484 Caring Way Unit F
Port Charlotte, FL 33952-5306

Mailing address

PO Box 2147
Fort Myers, FL 33902-2147
Phone (941) 625-1999

Other names 1

  • LCH-PEDS PC#1 Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586304000000",
    "number": "1164051405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2147",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339022147",
            "telephone_number": "941-625-1999",
            "fax_number": "941-625-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2484 CARING WAY UNIT F",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339525306",
            "telephone_number": "941-625-1999",
            "fax_number": "941-625-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEE MEMORIAL HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-08",
        "last_updated": "2020-04-08",
        "certification_date": "2020-04-08",
        "status": "A",
        "authorized_official_last_name": "NIEBERGALL",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "239-424-1446"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LCH-PEDS PC#1",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Charlotte, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.