1003856667 NPI number — JOHN L LYMAN MD

Table of content: JOHN L LYMAN MD (NPI 1003856667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003856667 NPI number — JOHN L LYMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYMAN
Provider First Name:
JOHN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1003856667
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4750 HEMPSTEAD STATION DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KETTERING
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45429-5164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-875-0136
Provider Business Mailing Address Fax Number:
937-619-4381

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45005-2584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-312-3656
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2006

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: 207P00000X , with the licence number:  35046423 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000326508 . This is a "BCBS FOR UVMC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000316956 . This is a "BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0536003 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104734195 . This is a "MICHIGAN MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 104808593 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000559819 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000360666 . This is a "BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000377131 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000493504 . This is a "ANTHEM/BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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