1700925393 NPI number — ELIZABETH M MCKINSEY LPT

Table of content: ELIZABETH M MCKINSEY LPT (NPI 1700925393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700925393 NPI number — ELIZABETH M MCKINSEY LPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKINSEY
Provider First Name:
ELIZABETH
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPT
Provider Gender Code:
F

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:
1700925393
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:
1 EDGEDALE DR
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28804-1701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-775-8088
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 WOODFIN PL
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28801-2463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-775-8088
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2007

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: 174400000X , with the licence number:  5558 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7210192 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 079HA . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".