Healthcare Provider Details

I. General information

NPI: 1437396256
Provider Name (Legal Business Name): LEE HEALTHCARE MEDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E MAIN ST
HAMILTON TX
76531-1954
US

IV. Provider business mailing address

PO BOX 628
HAMILTON TX
76531-0628
US

V. Phone/Fax

Practice location:
  • Phone: 254-386-3006
  • Fax: 254-386-3091
Mailing address:
  • Phone: 254-386-3006
  • Fax: 254-386-3091

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: MS. LUCY LEE
Title or Position: PRESIDENT
Credential: RN, MS
Phone: 254-386-8971