1710089446 NPI number — LINDA G ELDREDGE ED.D.

Table of content: LINDA G ELDREDGE ED.D. (NPI 1710089446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710089446 NPI number — LINDA G ELDREDGE ED.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELDREDGE
Provider First Name:
LINDA
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ED.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ELDREDGE-THOMPSON
Provider Other First Name:
LINDA
Provider Other Middle Name:
G.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ED.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710089446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4601 SPICEWOOD SPRINGS RD
Provider Second Line Business Mailing Address:
BLDG 4 SUITE 200
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-467-1376
Provider Business Mailing Address Fax Number:
512-467-8658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4601 SPICEWOOD SPRINGS RD
Provider Second Line Business Practice Location Address:
BLDG 4 SUITE 200
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-467-1376
Provider Business Practice Location Address Fax Number:
512-467-8658
Provider Enumeration Date:
09/02/2006

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: 103TC0700X , with the licence number:  24394 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: OOG95Y . This is a "BCBS PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".




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