Provider Demographics
NPI:1437396256
Name:LEE HEALTHCARE MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:LEE HEALTHCARE MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS
Authorized Official - Phone:254-386-8971
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:TX
Mailing Address - Zip Code:76531-0628
Mailing Address - Country:US
Mailing Address - Phone:254-386-3006
Mailing Address - Fax:254-386-3091
Practice Address - Street 1:116 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:TX
Practice Address - Zip Code:76531-1954
Practice Address - Country:US
Practice Address - Phone:254-386-3006
Practice Address - Fax:254-386-3091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6260070001Medicare NSC