1578643219 NPI number — RICHARD G LAMERE MD

Table of content: RICHARD G LAMERE MD (NPI 1578643219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578643219 NPI number — RICHARD G LAMERE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAMERE
Provider First Name:
RICHARD
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1578643219
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2648 HOLIDAY RANCH LOOP RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARK CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84060-6838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-655-1305
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2648 HOLIDAY RANCH LOOP RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARK CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84060-6838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-655-1305
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2006

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: 208000000X , with the licence number:  F7506 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 6264458 1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 133499 . This is a "PHCS PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 135136303 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135136308 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: LAMRE77731 . This is a "CCHIP PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 645823 . This is a "UHC PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 080350401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 140442814 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1750369203 . This is a "GRP NPI NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 135136304 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00U87Z . This is a "BCBSTX GRP PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4110727 . This is a "AETNA PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0906220 . This is a "CIGNA PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1640385 . This is a "FIRSTHEALTH PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 86700F . This is a "BCBSTX IND PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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