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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1881131423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE MEMORIAL HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-424-1500
Fax Number	:	239-424-4145

Provider Business Practice Location Address
First Line	:	4040 PALM BEACH BLVD
Second Line	:	SUITE F
City	:	FORT MYERS
State	:	FL
Zip	:	33916-3470
Country	:	US
Telephone Number	:	239-343-7100
Fax Number	:	239-694-8447

Authorized Official
Title or Position	:	CFO
Name	:	BENJAMIN SPENCE
Credential	:
Telephone Number	:	239-343-6014

Provider Enumeration Date	:	01/20/2017
Last Update Date	:	04/26/2023

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Practice Location Address:

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1033432265 — MANDI H WADE ARNP, CNM
Practice Location Address:

4040 PALM BEACH BLVD STE F
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33916-3470

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Directions to “LEE MEMORIAL HEALTH SYSTEM ” Practice Location

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