1386631620 NPI number — LEE CHARLES HINRICHSEN PT

Table of content: LEE CHARLES HINRICHSEN PT (NPI 1386631620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386631620 NPI number — LEE CHARLES HINRICHSEN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HINRICHSEN
Provider First Name:
LEE
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1386631620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 FISHER STREET, ROOM 1A-132
Provider Second Line Business Mailing Address:
81 MSGS/SGCUY
Provider Business Mailing Address City Name:
KEESLER AFB
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-376-0446
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 FISHER ST RM 1A-132
Provider Second Line Business Practice Location Address:
81 MSGS/SGCUY
Provider Business Practice Location Address City Name:
KEESLER AFB
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39534-2508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-376-0446
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2005

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: 225100000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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