1669879532 NPI number — LYNDSAY R SHIPP MD PLLC

Table of content: (NPI 1669879532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669879532 NPI number — LYNDSAY R SHIPP MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LYNDSAY R SHIPP MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1669879532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1158
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OXFORD
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38655-1158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-711-3266
Provider Business Mailing Address Fax Number:
662-371-1325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 SISK AVE STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38655-3413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-371-1326
Provider Business Practice Location Address Fax Number:
662-236-5010
Provider Enumeration Date:
11/20/2014

Additional Information

Authorized Official

Authorized Official Last Name:
OLMSTEAD-MCCRANEY
Authorized Official First Name:
JILL
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
662-371-1326

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 05408509 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com