1770583692 NPI number — LUCINDA SEAVER

Table of content: (NPI 1770583692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770583692 NPI number — LUCINDA SEAVER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUCINDA SEAVER
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:
TENNESSEE VALLEY IMAGING
Provider Other Organization Name Type Code:
3
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:
1770583692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 177
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTPOINT
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38486-0177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-724-0465
Provider Business Mailing Address Fax Number:
931-853-4243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
97 RAILROAD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTPOINT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38486-5310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-724-0465
Provider Business Practice Location Address Fax Number:
931-853-4243
Provider Enumeration Date:
07/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SEAVER
Authorized Official First Name:
LUCINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ULTRASONOGRAPHER
Authorized Official Telephone Number:
866-724-0465

Provider Taxonomy Codes

  • Taxonomy code: 2471S1302X , with the licence number:  MDX0000003533 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3790151 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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