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General NPI Number Information
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NPI Number | 1073558441
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Entity Type | Organization
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Legal Business Name | LEE FAMILY CLINIC INC
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 11/02/2007
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Provider Practice Location Address
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Address Line | 1610 W UNIVERSITY BLVD
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City | DURANT
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State | OK
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Zip | 74701-3045
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Country | US
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Telephone | 580-924-3400
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Fax | 580-924-7732
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Provider Business Mailing Address
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Address Line | PO BOX 1610
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City | DURANT
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State | OK
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Zip | 74702-1610
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Country | US
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Telephone | 580-924-3400
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Fax | 580-924-7732
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | CONNIE HOWARD
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Credential |
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Telephone | 580-924-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 207Q00000X
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License Number State | OK
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