1134203524 NPI number — DR. BARBARA LACEY MCMANUS DPH

Table of content: DR. BARBARA LACEY MCMANUS DPH (NPI 1134203524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134203524 NPI number — DR. BARBARA LACEY MCMANUS DPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCMANUS
Provider First Name:
BARBARA
Provider Middle Name:
LACEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LACEY
Provider Other First Name:
BARBARA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134203524
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 WHITE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSPORT
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37664-2044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-245-2181
Provider Business Mailing Address Fax Number:
423-245-7261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1425 E CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37664-2501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-245-2181
Provider Business Practice Location Address Fax Number:
423-245-7261
Provider Enumeration Date:
10/24/2006

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: 183500000X , with the licence number:  2181 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C002181 . This is a "PHARMACIST LICENSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com