Provider Demographics
NPI: | 1902466345 |
---|---|
Name: | LEE PRIMARY CARE CLINICS, PLLC |
Entity Type: | Organization |
Organization Name: | LEE PRIMARY CARE CLINICS, PLLC |
Other - Org Name: | ZEN PRIMARY CARE CLINICS, PLLC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRACTICE MANAGER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | SUZETTE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PROFIO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 603-828-5596 |
Mailing Address - Street 1: | 10016 SUMMIT CANYON DR |
Mailing Address - Street 2: | |
Mailing Address - City: | LAS VEGAS |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89144-4333 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 702-245-6979 |
Mailing Address - Fax: | 702-947-4757 |
Practice Address - Street 1: | 8530 W SUNSET RD STE 230 |
Practice Address - Street 2: | |
Practice Address - City: | LAS VEGAS |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89113-2245 |
Practice Address - Country: | US |
Practice Address - Phone: | 702-245-6979 |
Practice Address - Fax: | 702-947-4757 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-06-18 |
Last Update Date: | 2019-08-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |