Provider Demographics
NPI:1073558441
Name:LEE FAMILY CLINIC INC
Entity Type:Organization
Organization Name:LEE FAMILY CLINIC INC
Other - Org Name:UNIVERSITY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-924-3400
Mailing Address - Street 1:PO BOX 1610
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74702-1610
Mailing Address - Country:US
Mailing Address - Phone:580-924-3400
Mailing Address - Fax:580-924-7732
Practice Address - Street 1:1610 W UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3045
Practice Address - Country:US
Practice Address - Phone:580-924-3400
Practice Address - Fax:580-924-7732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207Q00000X207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKH99185Medicare UPIN
OKE09781Medicare UPIN
OKG89637Medicare UPIN
OKR10954Medicare UPIN
OKI26742Medicare UPIN
OKG88730Medicare UPIN
OKE09720Medicare UPIN
OKE09783Medicare UPIN
OKE69822Medicare UPIN
OKQ37912Medicare UPIN
OKI36843Medicare UPIN