Healthcare Provider Details

I. General information

NPI: 1801120720
Provider Name (Legal Business Name): LEE HEALTHCARE MEDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 NE BIG BEND TRL STE D
GLEN ROSE TX
76043-4913
US

IV. Provider business mailing address

PO BOX 628
HAMILTON TX
76531-0628
US

V. Phone/Fax

Practice location:
  • Phone: 254-897-1853
  • Fax:
Mailing address:
  • Phone: 254-386-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LUCY LEE
Title or Position: PRESIDENT
Credential:
Phone: 254-386-8971