1154514578 NPI number — MARJORIE LENOIR OD

Table of content: MARJORIE LENOIR OD (NPI 1154514578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154514578 NPI number — MARJORIE LENOIR OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LENOIR
Provider First Name:
MARJORIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LENOIR
Provider Other First Name:
MARJORIE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1154514578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 LEXINGTON DR
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39110-6969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-605-4423
Provider Business Mailing Address Fax Number:
601-605-4437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 LEXINGTON DR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39110-6969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-605-4423
Provider Business Practice Location Address Fax Number:
601-605-4437
Provider Enumeration Date:
08/20/2007

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: 152W00000X , with the licence number:  788 , 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: 04324730 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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