1124105374 NPI number — MS. LIN MELLO ALLEN LMT

Table of content: MS. LIN MELLO ALLEN LMT (NPI 1124105374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124105374 NPI number — MS. LIN MELLO ALLEN LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
LIN
Provider Middle Name:
MELLO
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMT
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:
1124105374
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 588
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MICANOPY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32667-0588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-215-5009
Provider Business Mailing Address Fax Number:
352-371-1721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2720 NW 6TH ST
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32609-2994
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-215-5009
Provider Business Practice Location Address Fax Number:
352-371-1721
Provider Enumeration Date:
11/01/2006

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: 225700000X , with the licence number:  MA 23446 , 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)