1891724282 NPI number — JENNIFER A LUNCEFORD PA

Table of content: JENNIFER A LUNCEFORD PA (NPI 1891724282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891724282 NPI number — JENNIFER A LUNCEFORD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUNCEFORD
Provider First Name:
JENNIFER
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCGLAUN
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891724282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 PENNY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75751-3244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-386-3386
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1730 B F TERRY BLVD STE 302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSENBERG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77471-5535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-989-2873
Provider Business Practice Location Address Fax Number:
713-568-3313
Provider Enumeration Date:
06/30/2006

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: 363A00000X , with the licence number:  PA02328 , 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: 8192NP . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P01492565 . This is a "RAIL ROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7057548 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 75-1976930-005 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 187881104 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8821NF . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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