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General NPI Number Information
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NPI Number | 1295102598
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Entity Type | Organization
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Legal Business Name | TLC MEDICAL CENTER LLC
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Dates
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Enumeration Date | 08/22/2015
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Last Update Date | 08/22/2015
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Provider Practice Location Address
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Address Line | 2040 COLLIER AVE SUITE A
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City | FORT MYERS
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State | FL
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Zip | 33901-8124
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Country | US
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Telephone | 239-645-3131
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Fax |
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Provider Business Mailing Address
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Address Line | 1411 SE 33RD ST
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City | CAPE CORAL
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State | FL
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Zip | 33904-4275
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Country | US
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Telephone | 239-645-3131
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACQUES HERVE DESIR
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Credential | ARNP
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Telephone | 239-645-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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