1114041035 NPI number — LYNDON FAMILY HEALTH CARE CLINIC

Table of content: (NPI 1114041035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114041035 NPI number — LYNDON FAMILY HEALTH CARE CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LYNDON FAMILY HEALTH CARE CLINIC
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:
LYNDON FAMILY HEALTH CLINIC
Provider Other Organization Name Type Code:
3
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:
1114041035
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4795
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66604-0795
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-478-9625
Provider Business Mailing Address Fax Number:
785-271-4392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1128 SW FAIRLAWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66604-2020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-478-9625
Provider Business Practice Location Address Fax Number:
785-271-4392
Provider Enumeration Date:
03/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEST
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
785-478-9625

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  44473 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110808 . This is a "KS BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: CK3569 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200258580A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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