Basic Information
| Provider Information | |||||||||
| NPI: | 1023599289 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEE COUNTY INTEGRATED CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1167 SPRATLIN PARK DR | ||||||||
| Address2: | |||||||||
| City: | GRAY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376156205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234673600 | ||||||||
| FaxNumber: | 4234673644 | ||||||||
| Practice Location | |||||||||
| Address1: | 34084 WILDERNESS RD | ||||||||
| Address2: | |||||||||
| City: | JONESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242637899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2763463590 | ||||||||
| FaxNumber: | 4234673644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2018 | ||||||||
| LastUpdateDate: | 08/27/2018 | ||||||||
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| AuthorizedOfficialLastName: | DENTON | ||||||||
| AuthorizedOfficialFirstName: | ROBIN | ||||||||
| AuthorizedOfficialMiddleName: | DENISE | ||||||||
| AuthorizedOfficialTitleorPosition: | UM COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 4234673600 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FRONTIER HEALTH | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.