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DSH100012J 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
Lee Behavioral Health Outpatient Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100012J
Medicare Provider Number
100012
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/17/2017
Participating Start Date
4/1/2017
Participating Approval Date
3/15/2017
Last Recertification Date
9/3/2019
Termination Date
Termination Reason
7/1/2020
Hospital Outpatient facility no longer eligible
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
12550 New Brittany Blvd
SUITE 100
Ft. Myers, FL 33907
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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