Provider Demographics
NPI:1689695702
Name:LYNNCORE MEDGROUP, INC
Entity Type:Organization
Organization Name:LYNNCORE MEDGROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-892-6226
Mailing Address - Street 1:5464 TEXOMA PKWY
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2142
Mailing Address - Country:US
Mailing Address - Phone:877-892-6226
Mailing Address - Fax:888-625-9899
Practice Address - Street 1:5464 TEXOMA PKWY
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2142
Practice Address - Country:US
Practice Address - Phone:877-892-6226
Practice Address - Fax:888-625-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0043228332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03571381Medicaid
AZ885618Medicaid
MI874649657Medicaid
CT003124518Medicaid
NE100251315000Medicaid
AR146253716Medicaid
GA688029645AMedicaid
TX166335301Medicaid
OK200059620AMedicaid
KS100371860AMedicaid
LA1467758Medicaid
IN200422920AMedicaid
MO625233903Medicaid
GA688029645AMedicaid
AZ885618Medicaid