Provider Demographics
NPI:1972838647
Name:LANCE MD LLC
Entity Type:Organization
Organization Name:LANCE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/BILLING
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:RENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-868-2921
Mailing Address - Street 1:12737 BEL RED RD
Mailing Address - Street 2:200
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2699
Mailing Address - Country:US
Mailing Address - Phone:206-979-5361
Mailing Address - Fax:
Practice Address - Street 1:12737 BEL RED RD
Practice Address - Street 2:200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2699
Practice Address - Country:US
Practice Address - Phone:206-979-5361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000475712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty