1013990175 NPI number — LYNDA A ANGELONE CRNA

Table of content: LYNDA A ANGELONE CRNA (NPI 1013990175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013990175 NPI number — LYNDA A ANGELONE CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANGELONE
Provider First Name:
LYNDA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHITEHEAD
Provider Other First Name:
LYNDA
Provider Other Middle Name:
CATHERINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013990175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1004 SOUTH ROCK STREET
Provider Second Line Business Mailing Address:
WESTLAKE ANESTHESIA GROUP, PA
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-279-0348
Provider Business Mailing Address Fax Number:
512-371-8788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5656 WEST BEE CAVES ROAD
Provider Second Line Business Practice Location Address:
SUITE M-302
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78746-5236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-697-3502
Provider Business Practice Location Address Fax Number:
512-697-3501
Provider Enumeration Date:
11/22/2005

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: 367500000X , with the licence number:  70297 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8Y1862 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 166840201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84187U . This is a "BC/BS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 166840203 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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