1518040856 NPI number — LINDA MCGILVERY BA

Table of content: LINDA MCGILVERY BA (NPI 1518040856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518040856 NPI number — LINDA MCGILVERY BA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGILVERY
Provider First Name:
LINDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BA
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:
1518040856
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3407 SHAMROCK COURT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAUTIER
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-497-0690
Provider Business Mailing Address Fax Number:
228-497-1363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
57 INDUSTRIAL PARK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUCEDALE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-947-4274
Provider Business Practice Location Address Fax Number:
601-947-4275
Provider Enumeration Date:
10/23/2006

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00018214 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com