Provider Demographics
NPI:1073026647
Name:LEE ACCIDENT CARE CLINIC, LLC
Entity Type:Organization
Organization Name:LEE ACCIDENT CARE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOLGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-908-0899
Mailing Address - Street 1:PO BOX 151850
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33915-1850
Mailing Address - Country:US
Mailing Address - Phone:239-908-0899
Mailing Address - Fax:239-791-5526
Practice Address - Street 1:1611 SANTA BARBARA BLVD STE 120
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-3479
Practice Address - Country:US
Practice Address - Phone:239-288-2908
Practice Address - Fax:239-288-2908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11936207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty