=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114409141
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEE MEMORIAL HEALTH SYSTEM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2018
-----------------------------------------------------
Last Update Date | 09/06/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13960 PLANTATION RD
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33912-4303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-343-1503
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16131 ROSERUSH CT
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33908-3634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-343-7344
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHEIF FINANCIAL OFFICER
-----------------------------------------------------
Name | BENJAMIN SPENCE
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 239-343-6014
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------