Basic Information
Provider Information | |||||||||
NPI: | 1477558906 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | COATS | ||||||||
FirstName: | LLOYD | ||||||||
MiddleName: | WAYNE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | COATS | ||||||||
OtherFirstName: | L. | ||||||||
OtherMiddleName: | WAYNE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | D.O. | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 272 HOSPITAL RD STE 6 | ||||||||
Address2: |   | ||||||||
City: | CHILLICOTHE | ||||||||
State: | OH | ||||||||
PostalCode: | 456019031 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7407794275 | ||||||||
FaxNumber: | 7407794257 | ||||||||
Practice Location | |||||||||
Address1: | 4437 STATE ROUTE 159 | ||||||||
Address2: | STE. 115 | ||||||||
City: | CHILLICOTHE | ||||||||
State: | OH | ||||||||
PostalCode: | 456017065 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7407798840 | ||||||||
FaxNumber: | 7407798849 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/21/2005 | ||||||||
LastUpdateDate: | 11/19/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: | 03/20/2006 | ||||||||
NPIReactivationDate: | 04/05/2006 | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/19/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34006282C | OH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 0187864 | 05 | OH |   | MEDICAID |