1669559340 NPI number — RAYMOND W. LINDEMANN

Table of content: (NPI 1669559340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669559340 NPI number — RAYMOND W. LINDEMANN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAYMOND W. LINDEMANN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LINDEMANN PHYSICAL THERAPY
Provider Other Organization Name Type Code:
5
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:
1669559340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1145 LYONS RD # D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45458-1875
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-434-0509
Provider Business Mailing Address Fax Number:
937-434-1825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1145 LYONS RD # D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTERVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45458-1875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-434-0509
Provider Business Practice Location Address Fax Number:
937-434-1825
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ABNER
Authorized Official First Name:
RAYLENE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
937-434-0509

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT1675 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000008219 . This is a "ANTHEM DME" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 125384133007 . This is a "MMO KETTERING" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 125384133006 . This is a "MMO HH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 12538413308 . This is a "MMO LEBANON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0542283 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 365572300 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 125384133003 . This is a "MMO CENTERVILLE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 126332170675 . This is a "HUMANA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000008218 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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