# LEE MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346415973
- **Authorized official:** KENNETH HOLST (CFO)
- **Authorized official phone:** (269) 783-3034

## Contact information

- **Practice address:** 520 MAIN ST, DOWAGIAC, MI 49047-1762
- **Practice address phone:** (269) 783-3052
- **Mailing address:** 420 W HIGH ST, DOWAGIAC, MI 49047-1943

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 04/24/2008
- **Last updated:** 04/24/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0A41004 | BCBSM PIN | — |