Healthcare Provider Details

I. General information

NPI: 1902379209
Provider Name (Legal Business Name): LEE MEMORIAL HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 DEL PRADO BLVD S
CAPE CORAL FL
33990-2618
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-424-3120
  • Fax: 239-343-4145
Mailing address:
  • Phone: 239-424-3120
  • Fax: 239-343-4145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH NIEBERGALL
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 239-424-1446