1700871993 NPI number — LCT INC

Table of content: (NPI 1700871993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700871993 NPI number — LCT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LCT INC
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:
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:
1700871993
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
62002 NBU20
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ESPANOLA
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87532-2711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-747-8639
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 SPRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESPANOLA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87532-3456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-753-7111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CARMEN
Authorized Official First Name:
LORI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
505-747-8639

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NM006426 . This is a "BCBS NM GROUP" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 17104505 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 430074229 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: NM026426 . This is a "NM BCBS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".