1538395835 NPI number — SANG HEE LEE CRNA

Table of content: SANG HEE LEE CRNA (NPI 1538395835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538395835 NPI number — SANG HEE LEE CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
SANG HEE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538395835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2606 PASS A GRILLE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETE BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33706-4198
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 6TH ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33701-4814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-823-2188
Provider Business Practice Location Address Fax Number:
727-828-0723
Provider Enumeration Date:
06/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  ARNP9189699 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00858717 . This is a "RR MCR LINKED TO GROUP # CF4811" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 001458600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: G004J . This is a "BCBS OF FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 106458200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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