Healthcare Provider Details

I. General information

NPI: 1972794121
Provider Name (Legal Business Name): LYNDER MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 MADISON AVE
COVINGTON KY
41014-1210
US

IV. Provider business mailing address

2040 MADISON AVE
COVINGTON KY
41014-1210
US

V. Phone/Fax

Practice location:
  • Phone: 859-525-6623
  • Fax: 859-525-6757
Mailing address:
  • Phone: 859-525-6623
  • Fax: 859-525-6757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number278390
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: LYNDA DELUCA-RAHE
Title or Position: RN/OWNER
Credential:
Phone: 859-525-6623