MEDICARE: LEE MEMORIAL HEALTH SYSTEM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114409141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE MEMORIAL HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	16131 ROSERUSH CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-3634
Country	:	US
Telephone Number	:	239-343-7344
Fax Number	:

Provider Business Practice Location Address
First Line	:	13960 PLANTATION RD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4303
Country	:	US
Telephone Number	:	239-343-1503
Fax Number	:

Authorized Official
Title or Position	:	CHEIF FINANCIAL OFFICER
Name	:	BENJAMIN SPENCE
Credential	:	DO
Telephone Number	:	239-343-6014

Provider Enumeration Date	:	09/06/2018
Last Update Date	:	09/06/2018

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