1689741472 NPI number — MRS. MARGARET LYNN TIMMERMAN EDS LPC

Table of content: MRS. MARGARET LYNN TIMMERMAN EDS LPC (NPI 1689741472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689741472 NPI number — MRS. MARGARET LYNN TIMMERMAN EDS LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIMMERMAN
Provider First Name:
MARGARET
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
EDS LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TIMMERMAN
Provider Other First Name:
M
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
EDS LPC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1689741472
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3821 LORNA ROAD
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
35244-1035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-989-8333
Provider Business Mailing Address Fax Number:
205-989-8339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3821 LORNA ROAD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
35244-1035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-989-8333
Provider Business Practice Location Address Fax Number:
205-989-8339
Provider Enumeration Date:
11/29/2006

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: 101YM0800X , with the licence number:  1116 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 51524719 . This is a "FED OUT OF STATE BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51094728 . This is a "AL & NON FED BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".