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DSH100012B LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL
Subdivision Name
THE OUTPATIENT CENTER AT HEALTHPARK COMMONS
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100012B
Medicare Provider Number
100012
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
3/5/2009
Participating Start Date
4/1/2009
Participating Approval Date
3/9/2009
Last Recertification Date
8/30/2022
Termination Date
Termination Reason
4/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
Lee Memorial Health System
Benjamin Spence, CFO
(239) 343-6014
Primary Contact
Lee Memorial Health System
Joseph Bitner, Compliance Officer
(239) 343-8602
Addresses
Street Address
16281 BASS ROAD
Suites 100 (Cardiovascular Services)
FORT MYERS, FL 33908
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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11/08-DOC RECD TO CONFIRM ELIG DSH ADJ%
03/05/2009
June 2025
June 2025
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