1750378758 NPI number — CYNTHIA LOCKERD DO

Table of Contents

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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