1609975440 NPI number — MR. JASON R LINDEMANN PT

Table of content: MR. JASON R LINDEMANN PT (NPI 1609975440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609975440 NPI number — MR. JASON R LINDEMANN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINDEMANN
Provider First Name:
JASON
Provider Middle Name:
R
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

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:
1609975440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1145 D. LYONS RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-434-0509
Provider Business Mailing Address Fax Number:
937-434-1825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1145 LYONS RD # D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45458-1875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-434-0509
Provider Business Practice Location Address Fax Number:
937-434-1825
Provider Enumeration Date:
09/21/2006

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:  PT-008779 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: PT8779 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000008368 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 365572300 . This is a "TRICARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 310979866026 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0542283 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 31097986600 . This is a "BWC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 365572300 . This is a "US DEPT LABOR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 125384133 . This is a "TRICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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