Dr. Samuel C. Lee, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

K0107 Issued in TX

Legal business name

DR. SAMUEL C. LEE, PA

Practice address

800 8TH Ave Ste 528
Fort Worth, TX 76104-2604

Phone

(817) 625-8818

Fax

(817) 625-7850

NPI assigned

Jan 9, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shelly Shea

Title

Enrollment Specialist

Phone

(817) 484-6274

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604620800000",
    "number": "1861677700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 8TH AVE STE 528",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042604",
            "telephone_number": "817-625-8818",
            "fax_number": "817-625-7850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 8TH AVE STE 528",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042604",
            "telephone_number": "817-625-8818",
            "fax_number": "817-625-7850"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2223 NE 28th St",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761067418",
            "country_code": "US",
            "telephone_number": "817-625-8818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DR. SAMUEL C. LEE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-09",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A",
        "authorized_official_last_name": "SHEA",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "ENROLLMENT SPECIALIST",
        "authorized_official_telephone_number": "817-484-6274"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K0107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.