| NPI | 1164051405 |
|---|---|
| Doing Business As | LCH-PEDS PC#1 |
| Entity Type | Organization |
| Authorized Contact | JOSEPH NIEBERGALL Credentialing Specialist 239-424-1446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2020-04-08 |