Provider Demographics
NPI:1164599445
Name:H.S. LEE M.D. PA
Entity Type:Organization
Organization Name:H.S. LEE M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:H
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-485-7284
Mailing Address - Street 1:P O BX 599
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-0599
Mailing Address - Country:US
Mailing Address - Phone:205-485-7284
Mailing Address - Fax:205-485-7392
Practice Address - Street 1:42030 HIGHWAY 195
Practice Address - Street 2:SUITE B
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-0599
Practice Address - Country:US
Practice Address - Phone:205-485-7284
Practice Address - Fax:205-485-7392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL7617174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51003590OtherBLUE CROSS BLUE SHIELD
ALC70828Medicare UPIN
AL1164599445Medicare PIN