1689140451 NPI number — NICHOLE LEMAY PA

Table of content: NICHOLE LEMAY PA (NPI 1689140451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689140451 NPI number — NICHOLE LEMAY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEMAY
Provider First Name:
NICHOLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVIS
Provider Other First Name:
NICHOLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689140451
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6069
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29171-6069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-744-4900
Provider Business Mailing Address Fax Number:
803-744-4938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2728 SUNSET BLVD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29169-4815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-744-4900
Provider Business Practice Location Address Fax Number:
803-744-4938
Provider Enumeration Date:
10/19/2018

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: 363AS0400X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 3269 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3940PA , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".