1659332559 NPI number — TINA L LUBSEN AU.D., CCC-A

Table of content: TINA L LUBSEN AU.D., CCC-A (NPI 1659332559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659332559 NPI number — TINA L LUBSEN AU.D., CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUBSEN
Provider First Name:
TINA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AU.D., CCC-A
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:
1659332559
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8800 SE SUNNYSIDE RD STE 300N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLACKAMAS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97015-5703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-286-2999
Provider Business Mailing Address Fax Number:
512-607-4893

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 HIGHWAY 78 E # G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35501-4083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-384-4895
Provider Business Practice Location Address Fax Number:
285-384-3227
Provider Enumeration Date:
03/30/2006

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: 237600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 237700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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