Provider Demographics
NPI:1841496460
Name:LEE MEMORIAL HEALTH SYSTEM
Entity type:Organization
Organization Name:LEE MEMORIAL HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIDGE-LILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-985-3580
Mailing Address - Street 1:9800 S HEALTHPARK DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-7603
Mailing Address - Country:US
Mailing Address - Phone:239-985-3580
Mailing Address - Fax:239-985-3589
Practice Address - Street 1:9800 S HEALTHPARK DR
Practice Address - Street 2:SUITE 205
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-7603
Practice Address - Country:US
Practice Address - Phone:239-985-3580
Practice Address - Fax:239-985-3589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL883750301Medicaid