NPIMap

Organization Active NPI

Longevity Center of Fort Myers, Inc.

  • Acupuncturist
  • Fort Myers, FL
National Provider Identifier
1245352194
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
License
AP 914 Issued in FL
Legal business name
LONGEVITY CENTER OF FORT MYERS, INC.
Practice address
12621 New Brittany Blvd
BLD 17
Fort Myers, FL 33907-3631
Phone
(239) 274-6188
Fax
(239) 274-6186
NPI assigned
Apr 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Carol S Leveque, APNPI 1891749370
Title
Vice President
Phone
(230) 274-6188

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
AcupuncturistGroup: 193400000X SINGLE SPECIALTY GROUP 171100000X AP 914 FL Primary

Addresses

Primary practice location

12621 New Brittany Blvd
BLD 17
Fort Myers, FL 33907-3631

Mailing address

12621 New Brittany Blvd.
BLD 17
Fort Myers, FL 33907
Phone (239) 274-6188

National Provider Directory

National Provider Directory

Locations

12621 New Brittany Blvd
Bldg 17
Fort Myers, FL 33907
Phone (239) 274-6188

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245352194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12621 NEW BRITTANY BLVD.",
            "address_2": "BLD 17",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "33907",
            "telephone_number": "239-274-6188",
            "fax_number": "239-274-6186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12621 NEW BRITTANY BLVD",
            "address_2": "BLD 17",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339073631",
            "telephone_number": "239-274-6188",
            "fax_number": "239-274-6186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY CENTER OF FORT MYERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LEVEQUE",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "230-274-6188",
        "authorized_official_credential": "AP"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": "FL",
            "license": "AP 914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.