Provider Demographics
NPI:1063677227
Name:SARAH LEE, M.D., L.L.C.
Entity Type:Organization
Organization Name:SARAH LEE, M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-757-7000
Mailing Address - Street 1:100 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334-2046
Mailing Address - Country:US
Mailing Address - Phone:318-757-7000
Mailing Address - Fax:318-757-7140
Practice Address - Street 1:100 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-2046
Practice Address - Country:US
Practice Address - Phone:318-757-7000
Practice Address - Fax:318-757-7140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-26
Last Update Date:2008-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08269R261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1395269Medicaid
LAC78763Medicare UPIN
LA5L486Medicare PIN