1396938171 NPI number — LAWRENCE M LINETT, MD, PLLC

Table of content: (NPI 1396938171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396938171 NPI number — LAWRENCE M LINETT, MD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWRENCE M LINETT, MD, PLLC
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:
1396938171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2595 S 17TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28401-7748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-791-2788
Provider Business Mailing Address Fax Number:
910-791-2711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
431 WESTERN BLVD STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28546-6823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-355-6000
Provider Business Practice Location Address Fax Number:
910-355-7533
Provider Enumeration Date:
08/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LINETT
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
910-791-2788

Provider Taxonomy Codes

  • Taxonomy code: 207QS0010X , with the licence number:  29322 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 52071 . This is a "BC/BS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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