1669426458 NPI number — LEE MEMORIAL HEALTH SYSTEM

Table of content: (NPI 1669426458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669426458 NPI number — LEE MEMORIAL HEALTH SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEE MEMORIAL HEALTH SYSTEM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669426458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 150107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPE CORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33915-0107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-242-6012
Provider Business Mailing Address Fax Number:
239-242-6088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13681 DOCTORS WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33912-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-768-5000
Provider Business Practice Location Address Fax Number:
239-768-8379
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GERMAN
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHEIF FINANCIAL OFFICER
Authorized Official Telephone Number:
239-242-6202

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000897366X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21066 . This is a "WELLCARE/STAYWELL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0150689 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: '01632553 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010225300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030371400 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11638B , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 530 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0071695 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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