1023311321 NPI number — SHIVA KUMAR LAM, MD, PA

Table of content: (NPI 1023311321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023311321 NPI number — SHIVA KUMAR LAM, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHIVA KUMAR LAM, MD, PA
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:
1023311321
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P. O. BOX 26100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-467-2840
Provider Business Mailing Address Fax Number:
512-692-9158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1407 W STASSNEY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78745-2947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-440-4800
Provider Business Practice Location Address Fax Number:
512-440-4836
Provider Enumeration Date:
12/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LAM
Authorized Official First Name:
ALLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
512-467-2840

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: TXB144749 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 096990903 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 305165801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: TXB144748 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 305165802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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