1467582312 NPI number — MS. LISA ANN COLEMAN MSW,PLCSW

Table of content: MARIO N SUMILANG CRNA (NPI 1356614168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467582312 NPI number — MS. LISA ANN COLEMAN MSW,PLCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLEMAN
Provider First Name:
LISA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW,PLCSW
Provider Gender Code:
F

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:
1467582312
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 157
Provider Second Line Business Mailing Address:
110 SOUTH 2ND STREET
Provider Business Mailing Address City Name:
ELLINGTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63638-7427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-323-0423
Provider Business Mailing Address Fax Number:
573-323-8931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 PHYSICIANS PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
POPLAR BLUFF
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63901-3930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-785-6536
Provider Business Practice Location Address Fax Number:
573-785-0345
Provider Enumeration Date:
03/07/2007

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 108985 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1467582312 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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