Provider Demographics
NPI:1811015902
Name:THYMIOS P LAMBROU LILBOURN MEDICAL CLINIC
Entity Type:Organization
Organization Name:THYMIOS P LAMBROU LILBOURN MEDICAL CLINIC
Other - Org Name:CHAFFEE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THYMIOS
Authorized Official - Middle Name:P
Authorized Official - Last Name:LAMBROU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-887-3010
Mailing Address - Street 1:537 W YOAKUM AVE
Mailing Address - Street 2:
Mailing Address - City:CHAFFEE
Mailing Address - State:MO
Mailing Address - Zip Code:63740-1825
Mailing Address - Country:US
Mailing Address - Phone:573-887-3010
Mailing Address - Fax:573-887-3004
Practice Address - Street 1:537 W YOAKUM AVE
Practice Address - Street 2:
Practice Address - City:CHAFFEE
Practice Address - State:MO
Practice Address - Zip Code:63740-1825
Practice Address - Country:US
Practice Address - Phone:573-887-3010
Practice Address - Fax:573-887-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO594017600Medicaid
MO263891Medicare ID - Type UnspecifiedRH MEDICARE