1558672626 NPI number — CALIFORNIA COLON AND RECTAL CANCER SCREENING CENTER LLC

Table of content: BRYAN JOSEPH LYNN MD (NPI 1447285226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558672626 NPI number — CALIFORNIA COLON AND RECTAL CANCER SCREENING CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA COLON AND RECTAL CANCER SCREENING CENTER LLC
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:
1558672626
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
451 E ALMOND AVE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
MADERA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93637-5562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-438-0017
Provider Business Mailing Address Fax Number:
559-438-8882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7121 N WHITNEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93720-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-438-0017
Provider Business Practice Location Address Fax Number:
559-438-8882
Provider Enumeration Date:
06/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
AKHTAR
Authorized Official First Name:
NAEEM
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
559-438-0017

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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