Provider Demographics
NPI:1538332085
Name:LLOYD PODIATRY GROUP INC
Entity Type:Organization
Organization Name:LLOYD PODIATRY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOHREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-336-2106
Mailing Address - Street 1:2117 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-3528
Mailing Address - Country:US
Mailing Address - Phone:765-642-3000
Mailing Address - Fax:765-642-3074
Practice Address - Street 1:2117 E 5TH ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-3528
Practice Address - Country:US
Practice Address - Phone:765-642-3000
Practice Address - Fax:765-642-3074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000551A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN6159450001Medicare NSC
IN256600Medicare PIN