NPI | 1619512803 |
---|---|
Doing Business As | LCH- PEDS LHCP |
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 | 2019-11-12 |
Last Update Date | 2020-03-27 |