Provider Demographics
NPI:1487039723
Name:MCGREGOR MEDICAL AND WELLNESS,LLC
Entity Type:Organization
Organization Name:MCGREGOR MEDICAL AND WELLNESS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAY JOY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-336-0842
Mailing Address - Street 1:581 OCEANSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-1835
Mailing Address - Country:US
Mailing Address - Phone:276-336-0842
Mailing Address - Fax:
Practice Address - Street 1:16731 MCGREGOR BLVD STE 105
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3876
Practice Address - Country:US
Practice Address - Phone:276-336-0842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110139261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care