Provider Demographics
NPI:1427341981
Name:MCGREGOR MEDICAL LLC
Entity type:Organization
Organization Name:MCGREGOR MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:FULK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-437-2121
Mailing Address - Street 1:16731 MCGREGOR BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3876
Mailing Address - Country:US
Mailing Address - Phone:239-437-2121
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:239-437-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care