Provider Demographics
NPI:1730139775
Name:LIMAYLLA, LUCY M (MD)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:M
Last Name:LIMAYLLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BAYOU RD
Mailing Address - Street 2:GREENVILLE
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-7702
Mailing Address - Country:US
Mailing Address - Phone:662-403-8579
Mailing Address - Fax:601-272-3434
Practice Address - Street 1:107 BAYOU RD
Practice Address - Street 2:GREENVILLE
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-7702
Practice Address - Country:US
Practice Address - Phone:662-403-8579
Practice Address - Fax:601-272-3434
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-00514207Q00000X
KS0431907207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200384430HMedicaid
KSKA1398019Medicare PIN