1073644175 NPI number — DR. WENDY S LANE MD

Table of content: DR. WENDY S LANE MD (NPI 1073644175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073644175 NPI number — DR. WENDY S LANE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANE
Provider First Name:
WENDY
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
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:
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:
1073644175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
122 WINDOVER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-684-8843
Provider Business Mailing Address Fax Number:
828-258-0864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
141 ASHELAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-258-2404
Provider Business Practice Location Address Fax Number:
828-258-0864
Provider Enumeration Date:
03/08/2007

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: 207RE0101X , with the licence number:  9800602 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2083P0901X , with the licence number: 9800602 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 891148Q , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 460003128 . This is a "RR MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1148Q . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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