Healthcare Provider Details

I. General information

NPI: 1235428889
Provider Name (Legal Business Name): LEE THOMAS CHURCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E HASKELL ST
WINNEMUCCA NV
89445-3299
US

IV. Provider business mailing address

PO BOX 143
COHASSET MN
55721-0143
US

V. Phone/Fax

Practice location:
  • Phone: 775-623-5222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number16373
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number64526
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number64526
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16373
License Number StateNV
# 5
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number64526
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number16373
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: