NPIMap

Organization Active NPI

Lee Memorial Health System

Doing business as GCHSWFL Charlotte County Pediatric Specialty Clinic

  • Federally Qualified Health Center (FQHC)
  • Port Charlotte, FL
National Provider Identifier
1205678240
Registry record updated Jun 11, 2024
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
Doing business as
GCHSWFL Charlotte County Pediatric Specialty Clinic
Practice address
22655 Bayshore Rd Ste 110
Port Charlotte, FL 33980-2005
Phone
(412) 354-9009
Fax
(941) 235-4901
NPI assigned
Jun 11, 2024
Last updated
Jun 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2024

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

Authorized official

Name
Vivian M Rodriguez
Title
Credentialing Specialist
Phone
(239) 424-1452

Specialties & licenses 1

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

Addresses

Primary practice location

22655 Bayshore Rd Ste 110
Port Charlotte, FL 33980-2005

Mailing address

PO Box 2147
Fort Myers, FL 33902-2147
Phone (941) 235-4900

Other names 1

  • GCHSWFL Charlotte County Pediatric Specialty Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lee Physician Group OB13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1718064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718064000000",
    "number": "1205678240",
    "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": "941-235-4900",
            "fax_number": "941-235-4901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22655 BAYSHORE RD STE 110",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339802005",
            "telephone_number": "412-354-9009",
            "fax_number": "941-235-4901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEE MEMORIAL HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-11",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "VIVIAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "239-424-1452"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GCHSWFL Charlotte County Pediatric Specialty Clinic",
            "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 Jun 11, 2024; 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.