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General NPI Number Information
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NPI Number | 1780475053
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Entity Type | Individual
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Provider Name | COREY TYRONE LEE BS MT
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Gender | Male
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Dates
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Enumeration Date | 05/15/2025
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | ROCKY BOY HEALTH CENTER 6850 UPPER BOX ELDER ROAD
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City | BOX ELDER
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State | MT
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Zip | 59521
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Country | US
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Telephone | 406-395-4486
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Fax |
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Provider Business Mailing Address
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Address Line | 655 S RIVERSIDE DR
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City | MEMPHIS
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State | TN
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Zip | 38103-4600
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Country | US
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Telephone | 901-870-5956
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246QM0706X
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Taxonomy Name | Medical Technologist
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License Number | 18454
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License Number State | TN
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