MEDICARE: LYNCH & LYNCH, PC

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
1	103TC0700X	Clinical Psychologist	574	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	400522283	OTHER	OK	MEDICARE GROUP

General Provider Information

NPI Number	:	1013074665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNCH & LYNCH, PC

Provider Business Mailing Address
First Line	:	6205 W GORE BLVD
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-5836
Country	:	US
Telephone Number	:	580-536-3900
Fax Number	:	580-357-8787

Provider Business Practice Location Address
First Line	:	6205 W GORE BLVD
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-5836
Country	:	US
Telephone Number	:	580-536-3900
Fax Number	:	580-357-8787

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JANA LYNCH
Credential	:
Telephone Number	:	580-536-3900

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	05/06/2009

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