MEDICARE: CHARLOTTE COUNTY HEALTH DEPARTMENT

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	251K00000X	Public Health or Welfare Agency	RN 1737082	FL

General Provider Information

NPI Number	:	1093986770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLOTTE COUNTY HEALTH DEPARTMENT

Provider Business Mailing Address
First Line	:	514 E GRACE ST
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-6121
Country	:	US
Telephone Number	:	941-639-1181
Fax Number	:	941-639-5669

Provider Business Practice Location Address
First Line	:	1994 KINGS HWY
Second Line	:
City	:	PT CHARLOTTE
State	:	FL
Zip	:	33980-4214
Country	:	US
Telephone Number	:	941-613-0950
Fax Number	:	941-613-0959

Authorized Official
Title or Position	:	ACCOUNTANT
Name	:	CHERYL LEMUNYON
Credential	:
Telephone Number	:	941-833-3500

Provider Enumeration Date	:	03/20/2008
Last Update Date	:	03/20/2008

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Directions to “CHARLOTTE COUNTY HEALTH DEPARTMENT ” Practice Location

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