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NPI Code Detail

MEDICARE: DR. CHARLES S LANE III MD

MEDICARE: DR. CHARLES S LANE III MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianC5421AR

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1260001316OTHERARRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2B002OTHERARWPS TRICARE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
453036OTHERARBLUE CROSS BLUE SHIELD AR

General Provider Information

NPI Number : 1427051663
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES S LANE III MD
Provider Business Mailing Address
First Line : PO BOX 6005
Second Line :
City : HOT SPRINGS
State : AR
Zip : 71902-6005
Country : US
Telephone Number : 501-802-0013
Fax Number : 501-623-1465
Provider Business Practice Location Address
First Line : 300 WERNER ST
Second Line :
City : HOT SPRINGS
State : AR
Zip : 71913-6406
Country : US
Telephone Number : 501-802-0013
Fax Number : 501-623-1465
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 05/04/2012

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