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DSH100012AW 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
Golisano Children's Hospital - Rehab Services
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100012AW
Medicare Provider Number
100012
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/9/2020
Participating Start Date
5/14/2020
Participating Approval Date
4/22/2020
Last Recertification Date
8/25/2021
Termination Date
Termination Reason
4/1/2022
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
9981 S. Healthpark Drive
Building 2- Children's Hospital
Fort Myers, FL 33908
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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