1255630471 NPI number — LCO GROUP, PA

Table of content: (NPI 1255630471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255630471 NPI number — LCO GROUP, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LCO GROUP, 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:
1255630471
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 OLD CAMP RD
Provider Second Line Business Mailing Address:
BUILDING 10, SUITE 112
Provider Business Mailing Address City Name:
THE VILLAGES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32162-5604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-728-3000
Provider Business Mailing Address Fax Number:
352-728-2603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 OLD CAMP RD
Provider Second Line Business Practice Location Address:
BUILDING 10, SUITE 112
Provider Business Practice Location Address City Name:
THE VILLAGES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32162-5604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-728-3000
Provider Business Practice Location Address Fax Number:
352-728-2603
Provider Enumeration Date:
03/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
COWIN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
LEAD PHYSICIAN
Authorized Official Telephone Number:
352-728-3000

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  ME36469 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 24500 . This is a "BCBS FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com