Provider Demographics
NPI:1073727756
Name:DR LLOYD C TRICHELL PA
Entity Type:Organization
Organization Name:DR LLOYD C TRICHELL PA
Other - Org Name:FAYETTEVILLE PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRICHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-587-0171
Mailing Address - Street 1:PO BOX 1705
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1705
Mailing Address - Country:US
Mailing Address - Phone:479-587-0171
Mailing Address - Fax:479-587-0885
Practice Address - Street 1:509 E MILLSAP RD
Practice Address - Street 2:STE. 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4067
Practice Address - Country:US
Practice Address - Phone:479-587-0171
Practice Address - Fax:479-587-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR116213E00000X
OK172213E00000X
TX0902213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5843039OtherAETNA
387675OtherHEALTHLINK
AR119165717Medicaid
AR15934000000OtherQUALCHOICE OF ARKANSAS
AR56240OtherCHAMPUS
AR148124748Medicaid
AR56240OtherBC/BS
2720061OtherUNITED HEALTHCARE
AR56240OtherCHAMPUS
2720061OtherUNITED HEALTHCARE
AR148124748Medicaid