1437401080 NPI number — ALL PRO HEALTH LLC

Table of content: MS. LYNN CHIYEKO MIKAMI OTR (NPI 1538364674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437401080 NPI number — ALL PRO HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALL PRO HEALTH LLC
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:
1437401080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1238 1ST AVE
Provider Second Line Business Mailing Address:
PO BOX 297
Provider Business Mailing Address City Name:
LAWRENCEBURG
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38464-2704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-244-7600
Provider Business Mailing Address Fax Number:
931-244-7601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1238 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38464-2704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-244-7600
Provider Business Practice Location Address Fax Number:
931-244-7601
Provider Enumeration Date:
10/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HUDGINS
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
931-244-7600

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  5331 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1530678 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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