1487072989 NPI number — EMERGENCY SURGICAL ASSOCIATES, APC

Table of content: LYNNE BETTEN LETCHNER LLMSW (NPI 1053666115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487072989 NPI number — EMERGENCY SURGICAL ASSOCIATES, APC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGENCY SURGICAL ASSOCIATES, APC
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:
1487072989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 TUSTIN AVE
Provider Second Line Business Mailing Address:
SUITE C, #1166
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92663-4729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-791-6752
Provider Business Mailing Address Fax Number:
949-791-6768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 SUPERIOR AVE
Provider Second Line Business Practice Location Address:
SUITE 200-G
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92663-3663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-791-6752
Provider Business Practice Location Address Fax Number:
949-791-6768
Provider Enumeration Date:
04/01/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SNYDER
Authorized Official First Name:
LINCOLN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-791-6752

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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