1831126184 NPI number — LYNN L CHARRLIN M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831126184 NPI number — LYNN L CHARRLIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHARRLIN
Provider First Name:
LYNN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1831126184
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
513 S MUCKEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAPLETON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51034-1055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-882-2234
Provider Business Mailing Address Fax Number:
712-423-9402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
513 S MUCKEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLETON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51034-1055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-882-2234
Provider Business Practice Location Address Fax Number:
712-423-9402
Provider Enumeration Date:
06/26/2006

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: 207Q00000X , with the licence number:  2002011470 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD-42176 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010568509 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 208369009 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33098051 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 540568508 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33098031 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33098041 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com