1619995396 NPI number — AMY I LYNCH PT

Table of content: AMY I LYNCH PT (NPI 1619995396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619995396 NPI number — AMY I LYNCH PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYNCH
Provider First Name:
AMY
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1619995396
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 0897
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT HADLOCK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98339-0897
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-385-9310
Provider Business Mailing Address Fax Number:
360-379-8826

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 COLWELL STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT HADLOCK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98339-0897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-385-9310
Provider Business Practice Location Address Fax Number:
360-379-8826
Provider Enumeration Date:
07/18/2006

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:  PT00007149 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8374696 . This is a "DSHS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7824409 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: G8862188 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: A003 . This is a "TRICARE WEST" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8374696 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5116LY . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8943400 . This is a "CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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