1972617876 NPI number — LEXINGTON PRIMARY CARE

Table of content: BERNARD J. BARILE PH.D. (NPI 1316177801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972617876 NPI number — LEXINGTON PRIMARY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEXINGTON PRIMARY CARE
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:
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:
1972617876
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 249
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39095-0249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-834-1855
Provider Business Mailing Address Fax Number:
662-834-4953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 TCHULA STREET
Provider Second Line Business Practice Location Address:
LEXINGTON PRIMARY CARE
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-834-1855
Provider Business Practice Location Address Fax Number:
662-834-4953
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HATHCOCK
Authorized Official First Name:
PAULINE
Authorized Official Middle Name:
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
662-834-1855

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  R851692 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0115646 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com