1215327168 NPI number — MR. LUKE LANCE KEENE SOIDC

Table of content: MR. LUKE LANCE KEENE SOIDC (NPI 1215327168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215327168 NPI number — MR. LUKE LANCE KEENE SOIDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEENE
Provider First Name:
LUKE
Provider Middle Name:
LANCE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
SOIDC
Provider Gender Code:
M

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:
1215327168
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3D MSOB
Provider Second Line Business Mailing Address:
PSC BOX 20073
Provider Business Mailing Address City Name:
CAMP LEJEUNE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28542-0073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-449-9967
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MARSOC
Provider Second Line Business Practice Location Address:
PSC BOX 20073
Provider Business Practice Location Address City Name:
CAMP LEJEUNE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28542-0073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-449-9967
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2015

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: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1265997380 . This is a "SOIDC MILITARY" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com