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	3336S0011X	Specialty Pharmacy
2	333600000X	Pharmacy
3	3336H0001X	Home Infusion Therapy Pharmacy	PH25005	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2133840	OTHER		PK

General Provider Information

NPI Number	:	1801196266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE MEMORIAL HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	11220 METRO PKWY STE 31
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-1291
Country	:	US
Telephone Number	:	239-343-9799
Fax Number	:	239-275-6931

Provider Business Practice Location Address
First Line	:	11220 METRO PKWY STE 31
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-1291
Country	:	US
Telephone Number	:	239-343-9799
Fax Number	:	239-275-6931

Authorized Official
Title or Position	:	DIRECTOR HOME INFUSION
Name	:	MICHAEL KOLEFF
Credential	:
Telephone Number	:	239-343-9799

Provider Enumeration Date	:	11/01/2010
Last Update Date	:	03/13/2024

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