Provider Demographics
NPI:1578653481
Name:LEE S HYDE AND GAIL HYDE PTR
Entity Type:Organization
Organization Name:LEE S HYDE AND GAIL HYDE PTR
Other - Org Name:HYGEIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:SANFORD
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-252-8341
Mailing Address - Street 1:22 NEW LEICESTER HWY STE A
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-2753
Mailing Address - Country:US
Mailing Address - Phone:828-252-8341
Mailing Address - Fax:828-254-2317
Practice Address - Street 1:22 NEW LEICESTER HWY STE A
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2753
Practice Address - Country:US
Practice Address - Phone:828-252-8341
Practice Address - Fax:828-254-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890138CMedicaid
NC0138COtherBCBS-NC PROVIDER #
NC=========OtherTAX ID#