1851386197 NPI number — MR. CARTER O LOMAX JR. M.D.

Table of content: MR. CARTER O LOMAX JR. M.D. (NPI 1851386197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851386197 NPI number — MR. CARTER O LOMAX JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOMAX
Provider First Name:
CARTER
Provider Middle Name:
O
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1851386197
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2854 S 11TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49009-2129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-345-6197
Provider Business Mailing Address Fax Number:
269-345-9734

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2854 S 11TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49009-2129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-345-6197
Provider Business Practice Location Address Fax Number:
269-345-9734
Provider Enumeration Date:
09/13/2005

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: 207V00000X , with the licence number:  CL045203 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1603909391 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1876740 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 730250 . This is a "PHP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 160038782 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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