Provider Demographics
NPI:1801196266
Name:LEE MEMORIAL HEALTH SYSTEM
Entity Type:Organization
Organization Name:LEE MEMORIAL HEALTH SYSTEM
Other - Org Name:LEE HEALTH HOME INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR HOME INFUSION
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-343-9799
Mailing Address - Street 1:11220 METRO PKWY STE 31
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1291
Mailing Address - Country:US
Mailing Address - Phone:239-343-9799
Mailing Address - Fax:239-275-6931
Practice Address - Street 1:11220 METRO PKWY STE 31
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1291
Practice Address - Country:US
Practice Address - Phone:239-343-9799
Practice Address - Fax:239-275-6931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
FLPH250053336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133840OtherPK