1477521680 NPI number — MRS. LINDA RUTH SCHOLER LEBEDOVYCH

Table of content: MRS. LINDA RUTH SCHOLER LEBEDOVYCH (NPI 1477521680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477521680 NPI number — MRS. LINDA RUTH SCHOLER LEBEDOVYCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEBEDOVYCH
Provider First Name:
LINDA
Provider Middle Name:
RUTH SCHOLER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEBEDOVYCH
Provider Other First Name:
LINDA
Provider Other Middle Name:
RUTH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1477521680
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3000 PIERCE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79930-4221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-353-9193
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5005 PIEDRAS AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-742-2520
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2006

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: 367500000X , with the licence number:  664060 , 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)





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