Provider Demographics
NPI:1922080530
Name:LEE'S SHOES, INC.
Entity Type:Organization
Organization Name:LEE'S SHOES, INC.
Other - Org Name:LESTER E LEE JR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:CFTS
Authorized Official - Phone:910-892-3035
Mailing Address - Street 1:203B N WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-4230
Mailing Address - Country:US
Mailing Address - Phone:910-892-3035
Mailing Address - Fax:910-892-8945
Practice Address - Street 1:203B N WILSON AVE
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4230
Practice Address - Country:US
Practice Address - Phone:910-892-3035
Practice Address - Fax:910-892-8945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703585Medicaid
NC7703585Medicaid
3940870001Medicare ID - Type Unspecified