Provider Demographics
NPI:1558313106
Name:SPEED, LEE E (PA)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:E
Last Name:SPEED
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1754
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18105-1754
Mailing Address - Country:US
Mailing Address - Phone:610-798-4500
Mailing Address - Fax:610-798-4699
Practice Address - Street 1:9125 CROSS PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4563
Practice Address - Country:US
Practice Address - Phone:865-632-5900
Practice Address - Fax:865-374-2129
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN1704363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3665361Medicaid
PA0993510OtherKEYSTONE CENTRAL
PAP00186451OtherRAILROAD MEDICARE
PA20045751OtherAMERIHEALTH MERCY
PA500443524OtherCAPITAL BLUE CROSS
PA0993510OtherKEYSTONE CENTRAL