Provider Demographics
NPI:1235595547
Name:IONA MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:IONA MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:R
Authorized Official - Last Name:SONN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-989-2586
Mailing Address - Street 1:15550 MCGREGOR BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-2579
Mailing Address - Country:US
Mailing Address - Phone:239-689-6820
Mailing Address - Fax:
Practice Address - Street 1:15550 MCGREGOR BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-2579
Practice Address - Country:US
Practice Address - Phone:239-689-6820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty