1861535247 NPI number — LYNDSEY D NEESE M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861535247 NPI number — LYNDSEY D NEESE M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

NEESE

Provider First Name:

LYNDSEY

Provider Middle Name:

D

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

YOUNGBLOOD

Provider Other First Name:

LYNDSEY

Provider Other Middle Name:

NEESE

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

MD

Provider Other Last Name Type Code:

1

NPI Number:

1861535247

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/21/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 776351

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

CHICAGO

Provider Business Mailing Address State Name:

IL

Provider Business Mailing Address Postal Code:

60677-6351

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

502-588-9490

Provider Business Mailing Address Fax Number:

502-272-5116

Provider First Line Business Practice Location Address:

4123 DUTCHMANS LN

Provider Second Line Business Practice Location Address:

SUITE 515

Provider Business Practice Location Address City Name:

LOUISVILLE

Provider Business Practice Location Address State Name:

KY

Provider Business Practice Location Address Postal Code:

40207-4707

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

502-629-2030

Provider Business Practice Location Address Fax Number:

502-629-2070

Provider Enumeration Date:

02/15/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207V00000X , with the licence number:  42493 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207V00000X , with the licence number: 01067170A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 000023036S . This is a "HUMANA - WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 7100072880 . This is a "MEDICAID KY - WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 105737 . This is a "SIHO - WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 4849132 . This is a "CIGNA - WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 200958320 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
• Identifier: 000000621161 . This is a "ANTHEM - WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: P00912080 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 00533141 . This is a "MEDICARE - KY - WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 50024842 . This is a "PASSPORT - WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: P00912101 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".