Provider Demographics
NPI:1043786833
Name:UNION MEDICAL GROUP
Entity Type:Organization
Organization Name:UNION MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEIDIER
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-315-9734
Mailing Address - Street 1:6300 CORPORATE CT STE 105
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3513
Mailing Address - Country:US
Mailing Address - Phone:239-315-9734
Mailing Address - Fax:
Practice Address - Street 1:6300 CORPORATE CT STE 105
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3513
Practice Address - Country:US
Practice Address - Phone:239-315-9734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty