1265667711 NPI number — G. LYMAN SHAW,D.C.,P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265667711 NPI number — G. LYMAN SHAW,D.C.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
G. LYMAN SHAW,D.C.,P.C.
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:
6
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:
1265667711
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 MOTIF BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNSBURG
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46112-1017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-852-3870
Provider Business Mailing Address Fax Number:
317-852-7417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 MOTIF BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46112-1017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-852-3870
Provider Business Practice Location Address Fax Number:
317-852-7417
Provider Enumeration Date:
05/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SHAW
Authorized Official First Name:
GARY
Authorized Official Middle Name:
LYMAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
317-852-3870

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X , with the licence number:  08001024 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NX0800X , with the licence number: 08001024 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 342260 . This is a "MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100133640 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com