1144366428 NPI number — LLOYD J. CLEAVER, D.O., L.L.C.

Table of content: (NPI 1144366428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144366428 NPI number — LLOYD J. CLEAVER, D.O., L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LLOYD J. CLEAVER, D.O., L.L.C.
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:
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:
1144366428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1316 COUNTRY CLUB DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIRKSVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63501-5362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-627-7546
Provider Business Mailing Address Fax Number:
660-956-7097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1316 COUNTRY CLUB DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63501-5362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-627-7546
Provider Business Practice Location Address Fax Number:
660-956-7096
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CLEAVER
Authorized Official First Name:
LLOYD
Authorized Official Middle Name:
JEROME
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
660-627-7546

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  R8895 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1295932648 . This is a "NPI (DAVID W. CLEAVER)" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 070004124 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: DG4290 . This is a "RAILROAD MEDICARE GROUP #" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1104829829 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2010022125 . This is a "MO LICENSE (DAVID W. CLEAVER)" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 242210912 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 501218200 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1063495463 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 428713812 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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