Provider Demographics
NPI:1780001420
Name:LANE PEDIATRICS PA
Entity Type:Organization
Organization Name:LANE PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-908-3593
Mailing Address - Street 1:7841 CAMBRIDGE MANOR PL STE C
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4635
Mailing Address - Country:US
Mailing Address - Phone:239-908-3593
Mailing Address - Fax:239-908-3597
Practice Address - Street 1:7841 CAMBRIDGE MANOR PL STE C
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4635
Practice Address - Country:US
Practice Address - Phone:239-908-3593
Practice Address - Fax:239-908-3597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty