1568958072 NPI number — LAUREN M LAMBERT

Table of content: LAUREN M LAMBERT (NPI 1568958072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568958072 NPI number — LAUREN M LAMBERT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAMBERT
Provider First Name:
LAUREN
Provider Middle Name:
M
Provider Name Prefix Text:
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:
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:
1568958072
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3515 RICHMOND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75503-0711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-831-7270
Provider Business Mailing Address Fax Number:
903-793-0496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 S DOUGLAS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDWEST CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73130-6221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-302-8999
Provider Business Practice Location Address Fax Number:
405-733-9360
Provider Enumeration Date:
07/09/2018

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: 363A00000X , with the licence number:  2925 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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