1316940893 NPI number — JEFFREY LUNDY M.D.

Table of content: JEFFREY LUNDY M.D. (NPI 1316940893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316940893 NPI number — JEFFREY LUNDY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUNDY
Provider First Name:
JEFFREY
Provider Middle Name:
Provider Name Prefix Text:
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:
1316940893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/17/2006
NPI Reactivation Date:
04/05/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W CHURCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38351-2038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-968-3646
Provider Business Mailing Address Fax Number:
731-968-1870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 W CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38351-2038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-968-3646
Provider Business Practice Location Address Fax Number:
731-968-1870
Provider Enumeration Date:
05/27/2005

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: 207Q00000X , with the licence number:  MD16241 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00293589 . This is a "MEDICARE RRGA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3888932 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".