Healthcare Provider Details

I. General information

NPI: 1902145915
Provider Name (Legal Business Name): LHAW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 2ND AVE N SUITE 304
NAPLES FL
34102-5753
US

IV. Provider business mailing address

2200 FORREST LN
NAPLES FL
34102-7621
US

V. Phone/Fax

Practice location:
  • Phone: 239-249-1428
  • Fax: 239-529-5491
Mailing address:
  • Phone: 239-249-1428
  • Fax: 239-529-5491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9101564
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME72991
License Number StateFL

VIII. Authorized Official

Name: MRS. BETH LEVINE
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 239-249-1428