1881131894 NPI number — MRS. LYNDSEY ZAJAC

Table of content: MRS. LYNDSEY ZAJAC (NPI 1881131894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881131894 NPI number — MRS. LYNDSEY ZAJAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZAJAC
Provider First Name:
LYNDSEY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEAVRIN
Provider Other First Name:
LYNDSEY
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881131894
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 SPRING ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
JEFFERSONVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47130-2930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-284-2273
Provider Business Mailing Address Fax Number:
812-284-2279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 SPRING ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
JEFFERSONVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47130-2930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-284-2273
Provider Business Practice Location Address Fax Number:
812-284-2279
Provider Enumeration Date:
01/27/2017

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: 363LF0000X , with the licence number:  71006843A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000001075147 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 300000766 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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