Healthcare Provider Details

I. General information

NPI: 1801196266
Provider Name (Legal Business Name): LEE MEMORIAL HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 03/13/2024
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11220 METRO PKWY STE 31
FORT MYERS FL
33966-1291
US

IV. Provider business mailing address

11220 METRO PKWY STE 31
FORT MYERS FL
33966-1291
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-9799
  • Fax: 239-275-6931
Mailing address:
  • Phone: 239-343-9799
  • Fax: 239-275-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPH25005
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL KOLEFF
Title or Position: DIRECTOR HOME INFUSION
Credential:
Phone: 239-343-9799