Provider Demographics
NPI:1336475789
Name:LEE MEMORIAL HEALTH SYSTEM
Entity Type:Organization
Organization Name:LEE MEMORIAL HEALTH SYSTEM
Other - Org Name:LEE MEMORIAL SENIOR BEHAVIOR UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:CHEIF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:GERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-242-6202
Mailing Address - Street 1:PO BOX 150107
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33915-0107
Mailing Address - Country:US
Mailing Address - Phone:239-242-6012
Mailing Address - Fax:239-242-6088
Practice Address - Street 1:2776 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-5864
Practice Address - Country:US
Practice Address - Phone:239-242-6012
Practice Address - Fax:239-242-6088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10-S012273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010110900Medicaid
FL10S012Medicare Oscar/Certification