1427164110 NPI number — LORI S. MCWILLIAMS GERSBACH MOT, OTR/L, CHT

Table of content: LORI S. MCWILLIAMS GERSBACH MOT, OTR/L, CHT (NPI 1427164110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427164110 NPI number — LORI S. MCWILLIAMS GERSBACH MOT, OTR/L, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCWILLIAMS GERSBACH
Provider First Name:
LORI
Provider Middle Name:
S.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MOT, OTR/L, CHT
Provider Gender Code:
F

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:
1427164110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10641
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79702-7641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-935-3479
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3416 W WALL ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79701-6710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-789-1055
Provider Business Practice Location Address Fax Number:
432-689-0907
Provider Enumeration Date:
08/22/2006

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: 225XH1200X , with the licence number:  107357 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 107357 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1011842 . This is a "NAT'L CERTIFICATION #" identifier . This identifiers is of the category "OTHER".




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