1124168323 NPI number — MR. KEVIN JOSEPH LUCAS LMT, CSIP

Table of content: MR. KEVIN JOSEPH LUCAS LMT, CSIP (NPI 1124168323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124168323 NPI number — MR. KEVIN JOSEPH LUCAS LMT, CSIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCAS
Provider First Name:
KEVIN
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMT, CSIP
Provider Gender Code:
M

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:
1124168323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12615 E MISSION AVE
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
SPOKANE VALLEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99216-1047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-891-2368
Provider Business Mailing Address Fax Number:
509-891-2368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12615 E MISSION AVE
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-891-2368
Provider Business Practice Location Address Fax Number:
509-891-2368
Provider Enumeration Date:
02/07/2007

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 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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