1720083900 NPI number — ANDREW W LYNN DPM

Table of content: ANDREW W LYNN DPM (NPI 1720083900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720083900 NPI number — ANDREW W LYNN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYNN
Provider First Name:
ANDREW
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1720083900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
659 EMORY VALLEY RD
Provider Second Line Business Mailing Address:
STE C
Provider Business Mailing Address City Name:
OAK RIDGE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37830-7764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-481-3338
Provider Business Mailing Address Fax Number:
865-481-0477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
659 EMORY VALLEY RD
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
OAK RIDGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37830-7764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-481-3338
Provider Business Practice Location Address Fax Number:
865-481-0477
Provider Enumeration Date:
06/15/2005

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: 213E00000X , with the licence number:  DPM0000000332 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3011580 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3351444 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4065733 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 2740012 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 2366703 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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