Provider Demographics
NPI:1679272710
Name:MIMS, LEMUEL
Entity Type:Individual
Prefix:
First Name:LEMUEL
Middle Name:
Last Name:MIMS
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 1:407 ELMHURST RD
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-2612
Mailing Address - Country:US
Mailing Address - Phone:315-404-4436
Mailing Address - Fax:
Practice Address - Street 1:407 ELMHURST RD
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-2612
Practice Address - Country:US
Practice Address - Phone:315-404-4436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty