1891955969 NPI number — DR. PAUL A. LINGOES M.D.

Table of content: DR. PAUL A. LINGOES M.D. (NPI 1891955969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891955969 NPI number — DR. PAUL A. LINGOES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINGOES
Provider First Name:
PAUL
Provider Middle Name:
A.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
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:
1891955969
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1624 MAIN STREET
Provider Second Line Business Mailing Address:
AGAPE SENIOR PRIMARY CARE, INC., DBA AGAPE PHYSICIANS C
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-454-0365
Provider Business Mailing Address Fax Number:
803-404-6000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 COLONIAL COMMONS
Provider Second Line Business Practice Location Address:
AGAPE PHYSICIANS CARE
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-207-8200
Provider Business Practice Location Address Fax Number:
803-207-8130
Provider Enumeration Date:
06/12/2008

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:  2020-03135 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: TL34607 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: RHC127 . This is a "RHC MEDICAID (LANCASTER)" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: RHC211 . This is a "RHC MEDICAID (INDIANLAND)" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 428960 . This is a "RHC MEDICARE (LANCASTER)" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: CE1315 . This is a "MEDICARE RAILROAD GROUP#" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP0641 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 346076 . This is a "INDIVIDUAL MEDICAID PROVIDER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 423876 . This is a "RHC MEDICARE (INDIANLAND)" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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