1952363913 NPI number — LILLIAN WHITLEY CAVIN MD

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 1952363913 NPI number — LILLIAN WHITLEY CAVIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAVIN
Provider First Name:
LILLIAN
Provider Middle Name:
WHITLEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHITLEY
Provider Other First Name:
LILLIAN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952363913
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22100 BOTHELL EVERETT HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOTHELL
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98021-8431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-416-2932
Provider Business Mailing Address Fax Number:
855-673-9190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5001 EVIDENCE CV
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPICEWOOD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-687-7237
Provider Business Practice Location Address Fax Number:
855-673-9190
Provider Enumeration Date:
04/05/2006

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: 2085R0202X , with the licence number:  M9063 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 0101235711 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: N9181 , 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: 3810010472 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64130479 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1563204 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 192640401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1952363913 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3323281 . This is a "MEDICARE 855R" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3425381000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00403950 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1019370340001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1071683 . This is a "WV WORKERS COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1552459 . This is a "AETHNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2746970 . This is a "OH MEDICAL ASSISTANCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 50017529 . This is a "PASSPORT-KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 02873783 . This is a "NY MEDICAL ASSISTANE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1963836 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 219077 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5W398CK23 . This is a "MEDICARE 855R, 855I PTAN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 7232314 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 91717 . This is a "SIHO-KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 101937034 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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