1497816516 NPI number — MRS. JUDITH JEAN CRITES-LUTZ L.P.C.

Table of content: MRS. JUDITH JEAN CRITES-LUTZ L.P.C. (NPI 1497816516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497816516 NPI number — MRS. JUDITH JEAN CRITES-LUTZ L.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRITES-LUTZ
Provider First Name:
JUDITH
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.P.C.
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:
1497816516
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1389
Provider Second Line Business Mailing Address:
16209 US HWY 160
Provider Business Mailing Address City Name:
FORSYTH
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65653-1389
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-546-6003
Provider Business Mailing Address Fax Number:
417-546-6005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
398 STATE HWY BB
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLISTER
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65673-0960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-334-2502
Provider Business Practice Location Address Fax Number:
417-334-6203
Provider Enumeration Date:
12/12/2006

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: 101YP2500X , with the licence number:  001802 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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