1679531339 NPI number — KIMBERLEY LENTZ MCKENNEY MD

Table of content: KIMBERLEY LENTZ MCKENNEY MD (NPI 1679531339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679531339 NPI number — KIMBERLEY LENTZ MCKENNEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKENNEY
Provider First Name:
KIMBERLEY
Provider Middle Name:
LENTZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LENTZ
Provider Other First Name:
KIMBERLEY
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679531339
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 19510
Provider Second Line Business Mailing Address:
FLORIDA UNITED RADIOLOGY
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33318-0510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-437-2672
Provider Business Mailing Address Fax Number:
954-851-1758

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20900 BISCAYNE BOULEVARD
Provider Second Line Business Practice Location Address:
AVENTURA HOSPITAL
Provider Business Practice Location Address City Name:
AVENTURA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-682-7398
Provider Business Practice Location Address Fax Number:
305-937-6988
Provider Enumeration Date:
05/03/2006

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: 2085R0202X , with the licence number:  ME61583 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 375398100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106618200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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