1336206044 NPI number — MR. LENNY J JOSEPH JR.

Table of content: MR. LENNY J JOSEPH JR. (NPI 1336206044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336206044 NPI number — MR. LENNY J JOSEPH JR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOSEPH
Provider First Name:
LENNY
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
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:
1336206044
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4183
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47724-0183
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-454-5588
Provider Business Mailing Address Fax Number:
888-424-4394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1741 OAK HILL RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47711-4371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-454-5588
Provider Business Practice Location Address Fax Number:
888-424-4394
Provider Enumeration Date:
01/02/2007

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: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200811860A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200810190A . This is a "MEDICAID WAIVER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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