1396709879 NPI number — DR. WILLIAM C LENNEN MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396709879 NPI number — DR. WILLIAM C LENNEN MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LENNEN

Provider First Name:

WILLIAM

Provider Middle Name:

C

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1396709879

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/21/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 11407

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BIRMINGHAM

Provider Business Mailing Address State Name:

AL

Provider Business Mailing Address Postal Code:

35246-1431

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

361-572-0333

Provider Business Mailing Address Fax Number:

361-703-5101

Provider First Line Business Practice Location Address:

759 S MAIN ST STE 200

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

WOODSTOCK

Provider Business Practice Location Address State Name:

VA

Provider Business Practice Location Address Postal Code:

22664-1156

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

540-459-1383

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

04/13/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207X00000X , with the licence number:  ME135530 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207X00000X , with the licence number: 0101048438 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207X00000X , with the licence number: D0043129 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207X00000X , with the licence number: MD20100 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 2127576 . This is a "ALLIANCE PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 3431-0005 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
• Identifier: 010149363 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 024222600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 144155 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 024222600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".