1073727756 NPI number — DR LLOYD C TRICHELL PA

Table of content: (NPI 1073727756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073727756 NPI number — DR LLOYD C TRICHELL PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR LLOYD C TRICHELL PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAYETTEVILLE PODIATRY
Provider Other Organization Name Type Code:
3
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:
1073727756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1705
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72702-1705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-587-0171
Provider Business Mailing Address Fax Number:
479-587-0885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
509 E MILLSAP RD
Provider Second Line Business Practice Location Address:
STE. 101
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72703-4067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-587-0171
Provider Business Practice Location Address Fax Number:
479-587-0885
Provider Enumeration Date:
05/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TRICHELL
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
479-587-0171

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  116 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X , with the licence number: 172 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 0902 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 5843039 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 387675 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 119165717 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 15934000000 . This is a "QUALCHOICE OF ARKANSAS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 56240 . This is a "CHAMPUS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 148124748 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56240 . This is a "BC/BS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 2720061 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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