1972052561 NPI number — LINCOLN ANESTHESIA SERVICES PLLC

Table of content: (NPI 1972052561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972052561 NPI number — LINCOLN ANESTHESIA SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINCOLN ANESTHESIA SERVICES PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1972052561
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1421
Provider Second Line Business Mailing Address:
106 MEDICAL CENTER BLVD - ATTN: PATSY LANGFORD,CRNA
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37334-1421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-438-7594
Provider Business Mailing Address Fax Number:
931-438-3252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 MEDICAL CENTER BLVD
Provider Second Line Business Practice Location Address:
ATTN: PATSY A. LANGFORD, CRNA - ANESTHESIA DEPT
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37334-2684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-438-7594
Provider Business Practice Location Address Fax Number:
931-438-3252
Provider Enumeration Date:
09/24/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LANGFORD
Authorized Official First Name:
PATSY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CRNA SR PARTNER OF LAS
Authorized Official Telephone Number:
256-763-9551

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  APN0000019604 , 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: 1437139433 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".