1699747915 NPI number — DURWARD LYNCH CNP

Table of content: DURWARD LYNCH CNP (NPI 1699747915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699747915 NPI number — DURWARD LYNCH CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYNCH
Provider First Name:
DURWARD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNP
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:
1699747915
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2901
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAYSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85547-2901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-468-8603
Provider Business Mailing Address Fax Number:
928-468-8625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
806 S PONDEROSA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAYSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85541-5541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-468-8603
Provider Business Practice Location Address Fax Number:
928-468-8625
Provider Enumeration Date:
02/02/2006

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: 363L00000X , with the licence number:  R31638 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: AP5348 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PROVP14270 . This is a "MOLINA" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 201006124 . This is a "PRESBYTERIAN HEALTH/SALUD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 332817 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 96361 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10002113 . This is a "LOVELACE HEALTH/SALUD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 500000924 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: NM00BT16 . This is a "BC/BS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com