1740719491 NPI number — MRS. LINDSAY RUNNELS CSA, STFA

Table of content: MRS. LINDSAY RUNNELS CSA, STFA (NPI 1740719491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740719491 NPI number — MRS. LINDSAY RUNNELS CSA, STFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUNNELS
Provider First Name:
LINDSAY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CSA, STFA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAVANAUGH
Provider Other First Name:
LINDSAY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ST
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740719491
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 EASTSIDE CV
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANDON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39047-7793
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-842-7355
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 HIGHLAND COLONY PKWY STE 27202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGELAND
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39157-2073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
769-300-2946
Provider Business Practice Location Address Fax Number:
769-300-2953
Provider Enumeration Date:
06/07/2017

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: 246ZC0007X , with the licence number:  4681 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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