1932153913 NPI number — TED A LENNARD M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932153913 NPI number — TED A LENNARD M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LENNARD

Provider First Name:

TED

Provider Middle Name:

A

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

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:

1932153913

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/21/2015

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 9434

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SPRINGFIELD

Provider Business Mailing Address State Name:

MO

Provider Business Mailing Address Postal Code:

65801-9434

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

417-885-3888

Provider Business Mailing Address Fax Number:

417-881-7638

Provider First Line Business Practice Location Address:

3801 S NATIONAL AVE

Provider Second Line Business Practice Location Address:

WEST TOWER, SUTIE 900

Provider Business Practice Location Address City Name:

SPRINGFIELD

Provider Business Practice Location Address State Name:

MO

Provider Business Practice Location Address Postal Code:

65807-5210

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

417-885-3888

Provider Business Practice Location Address Fax Number:

417-881-7638

Provider Enumeration Date:

05/22/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208100000X , with the licence number:  R9N55 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 208100000X , with the licence number: R3879 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208100000X , with the licence number: 0000032129 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208100000X , with the licence number: 18119 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 152849 . This is a "BLUE CROSS/CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 6354796002 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 202972212 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
• Identifier: 1842 . This is a "COX HEALTH PLAN UPI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 4188130001 . This is a "CIGNA MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 0201383 . This is a "DEPARTMENT OF LABOR WA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 168253001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
• Identifier: E35997 . This is a "USPS (W/C)" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".