| Dr. Samuel C. Lee, Pa | |
|
800 8th Ave Ste 528 Fort Worth TX 76104-2604 | |
| (817) 625-8818 | |
| (817) 625-7850 |
| Full Name | Dr. Samuel C. Lee, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 800 8th Ave Ste 528, Fort Worth, Texas |
| Authorized Official Name and Position | Shelly Shea (ENROLLMENT SPECIALIST) |
| Authorized Official Contact | 8174846274 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Samuel C. Lee, Pa 800 8th Ave Ste 528 Fort Worth TX 76104-2604 Ph: (817) 625-8818 | Dr. Samuel C. Lee, Pa 800 8th Ave Ste 528 Fort Worth TX 76104-2604 Ph: (817) 625-8818 |
| NPI Number | 1861677700 |
|---|---|
| Provider Enumeration Date | 01/09/2008 |
| Last Update Date | 11/06/2020 |
| Medicare PECOS PAC ID | 4082600440 |
|---|---|
| Medicare Enrollment ID | O20040421001491 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861677700 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | K0107 (Texas) | Primary |
| Provider Name | Samuel C Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770508376 PECOS PAC ID: 7012903495 Enrollment ID: I20101012001296 |
| Provider Name | Candice D Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972043131 PECOS PAC ID: 0244596740 Enrollment ID: I20171116002030 |
| Provider Name | Maria E Ramirez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447872007 PECOS PAC ID: 5193101665 Enrollment ID: I20221006001697 |
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