Active NPI
Edwina Faye Lee, DENTAL HYGIENIST
- Dental Hygienist
- San Fidel, NM
National Provider Identifier
1083828453
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 2038
- Practice address
- Exit 102 Off I40
1/2 Mi South
San Fidel, NM 87049 - Phone
- (505) 552-5310
- Fax
- (505) 552-5490
- NPI assigned
- May 9, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 2038 | AL | Primary |
Addresses
Primary practice location
Exit 102 Off I40
1/2 Mi South
San Fidel, NM 87049
Mailing address
PO Box 130
Acoma Canoncito Laguna Indian Hospital DHHS IHS
San Fidel, NM 87049-0130
Phone (505) 552-5385
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| H3451 | Medicaid | NM |
Other names 1
- Mrs. Edwina Lee Horn
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Acoma-Canoncito-Laguna Indian Health Center | Past | Accepting new patients | |
| Acoma Canoncito Laguna Indian | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba DHHS Usphs Indian Health Services
- Ambulance
- San Fidel, NM
- NPI 1649462532
-
- Health Service Clinic/Center
- Acoma, NM
- NPI 1225103922
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083828453",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 130",
"address_2": "ACOMA CANONCITO LAGUNA INDIAN HOSPITAL DHHS IHS",
"city": "SAN FIDEL",
"state": "NM",
"postal_code": "870490130",
"telephone_number": "505-552-5385",
"fax_number": "505-552-5473"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "EXIT 102 OFF I40",
"address_2": "1/2 MI SOUTH",
"city": "SAN FIDEL",
"state": "NM",
"postal_code": "87049",
"telephone_number": "505-552-5310",
"fax_number": "505-552-5490"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "EDWINA",
"middle_name": "FAYE",
"name_prefix": "Ms.",
"credential": "DENTAL HYGIENIST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "AL",
"license": "2038",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "H3451",
"state": "NM"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "EDWINA",
"last_name": "HORN",
"middle_name": "LEE",
"prefix": "MRS.",
"credential": "DENTAL HYGIENIST",
"code": "1",
"type": "Former Name"
}
]
}Other providers in San Fidel, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.