Provider Demographics
NPI:1932153913
Name:LENNARD, TED A (MD)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:A
Last Name:LENNARD
Suffix:
Gender:M
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:PO BOX 9434
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-9434
Mailing Address - Country:US
Mailing Address - Phone:417-885-3888
Mailing Address - Fax:417-881-7638
Practice Address - Street 1:3801 S NATIONAL AVE
Practice Address - Street 2:WEST TOWER, SUTIE 900
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5210
Practice Address - Country:US
Practice Address - Phone:417-885-3888
Practice Address - Fax:417-881-7638
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9N55208100000X
ARR3879208100000X
TN0000032129208100000X
LA18119208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO152849OtherBLUE CROSS/CHOICE
MO6354796002OtherCIGNA HEALTHCARE
MO202972212Medicaid
MO1842OtherCOX HEALTH PLAN UPI
MO4188130001OtherCIGNA MEDICARE
WA0201383OtherDEPARTMENT OF LABOR WA
AR168253001Medicaid
MOE35997OtherUSPS (W/C)
MOMA3058012Medicare PIN
MOE35997OtherUSPS (W/C)
MO4188130001OtherCIGNA MEDICARE
MO202972212Medicaid
MO6354796002OtherCIGNA HEALTHCARE
MO250013101Medicare PIN