Provider Demographics
NPI:1831390186
Name:PAUL M. LEE
Entity type:Organization
Organization Name:PAUL M. LEE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1765-492-4347
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47966-0340
Mailing Address - Country:US
Mailing Address - Phone:765-492-4347
Mailing Address - Fax:765-492-4839
Practice Address - Street 1:335 S. MAIN
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:IN
Practice Address - Zip Code:47966-0340
Practice Address - Country:US
Practice Address - Phone:765-492-4347
Practice Address - Fax:765-492-4839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0818341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22000000265655OtherANTHEM
IN200280Medicare ID - Type Unspecified