Provider Demographics
NPI:1992821094
Name:LYNDON MANSFIELD MD PA
Entity type:Organization
Organization Name:LYNDON MANSFIELD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMNISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-532-2663
Mailing Address - Street 1:2121 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-3508
Mailing Address - Country:US
Mailing Address - Phone:915-532-2663
Mailing Address - Fax:915-532-0054
Practice Address - Street 1:1901 ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5107
Practice Address - Country:US
Practice Address - Phone:915-532-2663
Practice Address - Fax:915-532-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158055701Medicaid
TX00793UMedicare ID - Type Unspecified