Provider Demographics
NPI:1093145542
Name:LINDELL, CHARLES WAYNE
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:WAYNE
Last Name:LINDELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:ACHILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74720-0104
Mailing Address - Country:US
Mailing Address - Phone:580-230-0104
Mailing Address - Fax:580-283-2093
Practice Address - Street 1:107 E BEECH
Practice Address - Street 2:
Practice Address - City:ACHILLE
Practice Address - State:OK
Practice Address - Zip Code:74720
Practice Address - Country:US
Practice Address - Phone:580-230-0104
Practice Address - Fax:580-283-2093
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications