MEDICARE: LEE COUNTY MEDICAL SOLUTIONS INC.

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	174400000X	Specialist	PMC56	FL

General Provider Information

NPI Number	:	1811213184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE COUNTY MEDICAL SOLUTIONS INC.

Provider Business Mailing Address
First Line	:	3822 BROADWAY STE C
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8148
Country	:	US
Telephone Number	:	239-274-3004
Fax Number	:	239-274-6007

Provider Business Practice Location Address
First Line	:	3822 BROADWAY STE C
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8148
Country	:	US
Telephone Number	:	239-274-3004
Fax Number	:	239-274-6007

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	THOMAS W JOSLYN
Credential	:
Telephone Number	:	239-274-3004

Provider Enumeration Date	:	04/12/2010
Last Update Date	:	04/12/2010

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