MEDICARE: LEHIGH ACCIDENT CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	261QR0400X	Rehabilitation Clinic/Center	CH11936	FL

General Provider Information

NPI Number	:	1235642711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEHIGH ACCIDENT CARE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 151850
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33915-1850
Country	:	US
Telephone Number	:	239-908-0899
Fax Number	:	239-791-5526

Provider Business Practice Location Address
First Line	:	1530 LEE BLVD STE 1700
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-4897
Country	:	US
Telephone Number	:	239-288-2908
Fax Number	:	239-791-5526

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES BOLGER
Credential	:	DC
Telephone Number	:	239-908-0899

Provider Enumeration Date	:	11/07/2017
Last Update Date	:	11/07/2017

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Directions to “LEHIGH ACCIDENT CARE, LLC ” Practice Location

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