Provider Demographics
NPI:1083657753
Name:AMELIA GAYLE LEE
Entity Type:Organization
Organization Name:AMELIA GAYLE LEE
Other - Org Name:A PLUS MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-566-1938
Mailing Address - Street 1:PO BOX 275
Mailing Address - Street 2:530 HUNTER AVE.
Mailing Address - City:BOSWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74727-0275
Mailing Address - Country:US
Mailing Address - Phone:580-566-1938
Mailing Address - Fax:580-566-1939
Practice Address - Street 1:530 HUNTER AVE
Practice Address - Street 2:
Practice Address - City:BOSWELL
Practice Address - State:OK
Practice Address - Zip Code:74727-0275
Practice Address - Country:US
Practice Address - Phone:580-566-1938
Practice Address - Fax:580-566-1939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK-1504-XX-O332B00000X
OK39-S-1120332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200062240AMedicaid
OK200114960AMedicaid
OK200114960AMedicaid
OK5509340001Medicare NSC