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General NPI Number Information
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NPI Number | 1194115204
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Entity Type | Organization
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Legal Business Name | LEE COUNTY MEDICAL GROUP CORP
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Dates
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Enumeration Date | 01/27/2015
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 742 FULLER AVE S
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City | LEHIGH ACRES
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State | FL
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Zip | 33974-7576
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Country | US
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Telephone | 239-274-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 742 FULLER AVE S
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City | LEHIGH ACRES
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State | FL
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Zip | 33974-7576
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SERGIO LUIS SALOME
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Credential |
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Telephone | 239-747-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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