1457487944 NPI number — V. THOMAS MAWHINNEY, PH.D., INC.

Table of content: CHING YIN LEE MD (NPI 1659612919)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457487944 NPI number — V. THOMAS MAWHINNEY, PH.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
V. THOMAS MAWHINNEY, PH.D., INC.
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:
6
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:
1457487944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
828 E COLFAX AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH BEND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46617-2804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-251-1531
Provider Business Mailing Address Fax Number:
574-234-5710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
828 E COLFAX AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH BEND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46617-2804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-251-1531
Provider Business Practice Location Address Fax Number:
574-234-5710
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MAWHINNEY
Authorized Official First Name:
VAUGHN
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
574-251-1531

Provider Taxonomy Codes

  • Taxonomy code: 103TB0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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