Provider Demographics
NPI:1295854180
Name:LEE FAMILY CLINIC
Entity Type:Organization
Organization Name:LEE FAMILY CLINIC
Other - Org Name:UNIVERSITY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:D
Authorized Official - Last Name:DOWNS
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:580-924-2000
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:580-924-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0192410001Medicare NSC