Provider Demographics
NPI:1982658407
Name:LEE MEMORIAL HEALTH SYSTEM
Entity Type:Organization
Organization Name:LEE MEMORIAL HEALTH SYSTEM
Other - Org Name:GULF COAST MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-343-6012
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:239-424-1503
Mailing Address - Fax:239-424-1599
Practice Address - Street 1:13681 DOCTORS WAY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4300
Practice Address - Country:US
Practice Address - Phone:239-424-1503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
0082074OtherAETNA
NY01637067Medicaid
WV9810088000Medicaid
GA000443286XMedicaid
MI304861581Medicaid
FL000035955OtherHUMANA
OH2072402Medicaid
FL568OtherBLUE CROSS
FL011134100Medicaid
035577800OtherBLACK LUNG
20944OtherWELLCARE/STAYWELL
NY01637067Medicaid
035577800OtherBLACK LUNG