Provider Demographics
NPI:1891756912
Name:PSYCHIATRY LEE AND ASSOCIATES PC
Entity Type:Organization
Organization Name:PSYCHIATRY LEE AND ASSOCIATES PC
Other - Org Name:LEE & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANG
Authorized Official - Middle Name:OUG
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-574-6120
Mailing Address - Street 1:804 KENYON ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5742
Mailing Address - Country:US
Mailing Address - Phone:515-574-6120
Mailing Address - Fax:515-574-6125
Practice Address - Street 1:804 KENYON ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5742
Practice Address - Country:US
Practice Address - Phone:515-574-6120
Practice Address - Fax:515-574-6125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA005961041C0700X
IA214562084P0800X
IAI059525363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0091223Medicaid
IA10195OtherBLUE CROSS BLUE SHIELD
IA10195Medicare ID - Type Unspecified