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NPI Code Detail

MEDICARE: LOCK HAVEN MEDICAL PROFESSIONALS, P.C.

MEDICARE: LOCK HAVEN MEDICAL PROFESSIONALS, P.C.
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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1861434912
Entity Type Code : Organization
Provider Name (Legal Business Name) : LOCK HAVEN MEDICAL PROFESSIONALS, P.C.
Provider Business Mailing Address
First Line : 7100 COMMERCE WAY
Second Line : SUITE 180
City : BRENTWOOD
State : TN
Zip : 37027-2829
Country : US
Telephone Number : 615-465-7000
Fax Number :
Provider Business Practice Location Address
First Line : 24 CREE DR
Second Line :
City : LOCK HAVEN
State : PA
Zip : 17745-2639
Country : US
Telephone Number : 570-893-5191
Fax Number : 570-893-5333
Authorized Official
Title or Position : DIRECTOR OF PROVIDER ENROLLMENT
Name : DEBBIE T BREWER
Credential :
Telephone Number : 615-465-7626
Provider Enumeration Date : 06/12/2006
Last Update Date : 01/21/2008

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