1194761494 NPI number — THOMAS G LEMKE MD

Table of content: THOMAS G LEMKE MD (NPI 1194761494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194761494 NPI number — THOMAS G LEMKE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEMKE
Provider First Name:
THOMAS
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1194761494
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:
3850 FOOTHILLS RD
Provider Second Line Business Mailing Address:
STE 9
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88011-4632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-532-8800
Provider Business Mailing Address Fax Number:
505-532-5920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4311 E LOHMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88011-8255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-532-8800
Provider Business Practice Location Address Fax Number:
505-532-5920
Provider Enumeration Date:
06/22/2006

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: 207P00000X , with the licence number:  2003-0551 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 51138832 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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