Provider Demographics
NPI:1619153715
Name:J. STEPHEN LEMLEY MD PC
Entity Type:Organization
Organization Name:J. STEPHEN LEMLEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:LEMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-591-4698
Mailing Address - Street 1:3210 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5188
Mailing Address - Country:US
Mailing Address - Phone:719-591-4698
Mailing Address - Fax:719-591-8835
Practice Address - Street 1:3210 N ACADEMY BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5188
Practice Address - Country:US
Practice Address - Phone:719-591-4698
Practice Address - Fax:719-591-8835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27587207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01275874Medicaid
CO01275874Medicaid
COC53321Medicare PIN