Provider Demographics
NPI:1164936464
Name:KENTON L. LINGAFELTER
Entity Type:Organization
Organization Name:KENTON L. LINGAFELTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:480-320-4730
Mailing Address - Street 1:4530 E SHEA BLVD STE 175
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6084
Mailing Address - Country:US
Mailing Address - Phone:480-320-4730
Mailing Address - Fax:602-971-2147
Practice Address - Street 1:4530 E SHEA BLVD STE 175
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6084
Practice Address - Country:US
Practice Address - Phone:480-320-4730
Practice Address - Fax:602-971-2147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-22
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty