1760559801 NPI number — AUSTIN LANE SEDICUM III DPM

Table of content: MRS. LADONNA LYNNELL LUCKEY M.S., LPC, LADC-MH (NPI 1255533873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760559801 NPI number — AUSTIN LANE SEDICUM III DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEDICUM
Provider First Name:
AUSTIN
Provider Middle Name:
LANE
Provider Name Prefix Text:
Provider Name Suffix Text:
III
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:
1760559801
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1040 S WEST END BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUAKERTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-529-6511
Provider Business Mailing Address Fax Number:
215-529-6512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 S WEST END BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUAKERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-529-6511
Provider Business Practice Location Address Fax Number:
215-529-6512
Provider Enumeration Date:
11/30/2006

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: 213E00000X , with the licence number:  SC005511 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2941264 . This is a "AETNA HMO PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1418639 . This is a "BS GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 063479Q2K . This is a "MEDICARE INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2103588000 . This is a "KEYSTONE INDIVIDUAL GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7802379 . This is a "AETNA PPO PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50010317 . This is a "CAPITAL GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 063480 . This is a "MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50016192 . This is a "CAPITAL INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2105345000 . This is a "KEYSTONE GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1417165 . This is a "BS INDIVIDUAL" identifier . This identifiers is of the category "OTHER".




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