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NPI Code Detail

MEDICARE: LEE COUNTY TRAUMA SERVICES DISTRICT

MEDICARE: LEE COUNTY TRAUMA SERVICES DISTRICT
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
12086S0127XTrauma Surgery Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639226608
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEE COUNTY TRAUMA SERVICES DISTRICT
Provider Business Mailing Address
First Line : PO BOX 2147
Second Line :
City : FORT MYERS
State : FL
Zip : 33902-2147
Country : US
Telephone Number : 239-424-1500
Fax Number : 239-424-1423
Provider Business Practice Location Address
First Line : 13685 DOCTORS WAY STE 100
Second Line :
City : FORT MYERS
State : FL
Zip : 33912-4337
Country : US
Telephone Number : 239-343-1612
Fax Number : 239-343-4229
Authorized Official
Title or Position : PRESIDENT,CEO
Name : LARRY ANTONUCCI
Credential :
Telephone Number : 239-343-6537
Provider Enumeration Date : 01/04/2007
Last Update Date : 11/06/2023

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Directions to “LEE COUNTY TRAUMA SERVICES DISTRICT ” Practice Location

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