Provider Demographics
NPI:1669507653
Name:CHILDREN'S MEDICAL SERVICES
Entity Type:Organization
Organization Name:CHILDREN'S MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DILL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:239-433-6723
Mailing Address - Street 1:9800 S HEALTHPARK DR
Mailing Address - Street 2:STE 405
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-7603
Mailing Address - Country:US
Mailing Address - Phone:239-433-6723
Mailing Address - Fax:239-433-6739
Practice Address - Street 1:9800 S HEALTHPARK DR
Practice Address - Street 2:STE 405
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-7603
Practice Address - Country:US
Practice Address - Phone:239-433-6723
Practice Address - Fax:239-433-6739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55038800Medicaid