1447349527 NPI number — LAURA LYNN SCROGGINS L.P.T.

Table of content: LAURA LYNN SCROGGINS L.P.T. (NPI 1447349527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447349527 NPI number — LAURA LYNN SCROGGINS L.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCROGGINS
Provider First Name:
LAURA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAWRENCE
Provider Other First Name:
LAURA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447349527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1403 W FERDON ST
Provider Second Line Business Mailing Address:
STE 20
Provider Business Mailing Address City Name:
LITCHFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62056-4448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-324-6997
Provider Business Mailing Address Fax Number:
217-324-6992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1403 W FERDON ST
Provider Second Line Business Practice Location Address:
STE 20
Provider Business Practice Location Address City Name:
LITCHFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62056-4448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-324-6997
Provider Business Practice Location Address Fax Number:
217-324-6992
Provider Enumeration Date:
10/12/2006

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: 225100000X , with the licence number:  070012784 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 371404054 . This is a "GROUP HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 371404054 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 448117 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 133693100 . This is a "OFFICE OF WORKERS COMPENS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 7499545 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2281494 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 05927690 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 371404054001 . This is a "TRICARE FOR LIFE" identifier . This identifiers is of the category "OTHER".




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