1659430858 NPI number — MRS. LYNDA MANN COOK LCAS

Table of content: MRS. LYNDA MANN COOK LCAS (NPI 1659430858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659430858 NPI number — MRS. LYNDA MANN COOK LCAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOK
Provider First Name:
LYNDA
Provider Middle Name:
MANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCAS
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:
1659430858
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:
PO BOX 355
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WENTWORTH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-342-8316
Provider Business Mailing Address Fax Number:
336-342-8352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 NC 65
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WENTWORTH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27375-0355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-342-8316
Provider Business Practice Location Address Fax Number:
336-342-8352
Provider Enumeration Date:
12/06/2006

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: 101YA0400X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6111832 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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