Basic Information
Provider Information | |||||||||
NPI: | 1891955969 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LINGOES | ||||||||
FirstName: | PAUL | ||||||||
MiddleName: | A. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1624 MAIN STREET | ||||||||
Address2: | AGAPE SENIOR PRIMARY CARE, INC., DBA AGAPE PHYSICIANS C | ||||||||
City: | COLUMBIA | ||||||||
State: | SC | ||||||||
PostalCode: | 29201 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8034540365 | ||||||||
FaxNumber: | 8034046000 | ||||||||
Practice Location | |||||||||
Address1: | 1201 COLONIAL COMMONS | ||||||||
Address2: | AGAPE PHYSICIANS CARE | ||||||||
City: | LANCASTER | ||||||||
State: | SC | ||||||||
PostalCode: | 29720 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8032078200 | ||||||||
FaxNumber: | 8032078130 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/12/2008 | ||||||||
LastUpdateDate: | 09/17/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | TL34607 | SC | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | GP0641 | 05 | SC |   | MEDICAID | 423876 | 01 | SC | RHC MEDICARE (INDIANLAND) | OTHER | CE1315 | 01 | SC | MEDICARE RAILROAD GROUP# | OTHER | RHC127 | 01 | SC | RHC MEDICAID (LANCASTER) | OTHER | 428960 | 01 | SC | RHC MEDICARE (LANCASTER) | OTHER | 346076 | 01 | SC | INDIVIDUAL MEDICAID PROVIDER | OTHER | RHC211 | 01 | SC | RHC MEDICAID (INDIANLAND) | OTHER |