1750378758 NPI number — CYNTHIA LOCKERD DO

Table of content: CYNTHIA LOCKERD DO (NPI 1750378758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750378758 NPI number — CYNTHIA LOCKERD DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOCKERD
Provider First Name:
CYNTHIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOCKERD
Provider Other First Name:
SISTER MARIE PAUL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1750378758
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
803 4TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56143-1056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-847-3571
Provider Business Mailing Address Fax Number:
507-847-5664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1717 N HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48906-4529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-371-1700
Provider Business Practice Location Address Fax Number:
517-371-4245
Provider Enumeration Date:
10/04/2005

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: 207Q00000X , with the licence number:  5101011388 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 35741 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NA2081015126 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 700B960280 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1750378758 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0115319 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 111661 . This is a "UCARE MINNESOTA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 791590000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1063376 . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2M018LO . This is a "BCBS MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 120002169 . This is a "PALMETTO GBA RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21394 . This is a "SIOUX VALLEY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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