1962760330 NPI number — MR. RYAN J SZTORCH LCP, LLC

Table of content: MR. RYAN J SZTORCH LCP, LLC (NPI 1962760330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962760330 NPI number — MR. RYAN J SZTORCH LCP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SZTORCH
Provider First Name:
RYAN
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCP, LLC
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1962760330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4940 MULLEN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAWNEE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66216-1275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-406-4999
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
708 W 9TH ST
Provider Second Line Business Practice Location Address:
#106
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66044-2893
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-371-6554
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2012

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: 103T00000X , with the licence number:  1435 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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