Clyde Milton Lockett Jr.

Primary specialty

ContractorTaxonomy code 171W00000X

Practice address

1251 N Eddy St Ste 200
South Bend, IN 46617-1478

Phone

(219) 312-1020

NPI assigned

Sep 1, 2021

Last updated

Sep 1, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1630454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630454400000",
    "number": "1174291520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 312",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463080312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1251 N EDDY ST STE 200",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171478",
            "telephone_number": "219-312-1020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOCKETT",
        "first_name": "CLYDE",
        "middle_name": "MILTON",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-09-01",
        "last_updated": "2021-09-01",
        "certification_date": "2021-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie Lipsey, RBT
• Annalise Lira, CF-SLP
• Janann K Lishawa, DPT
• Michael Littell, DDS
• Carrie Little
• Amelia Lockman
• Evans Kirkwood Lodge, MD, PHD
• Lindsay J Loewe
• Glenn Lofy, OTR/CLT/CKTP
• Logan Community Resources

• Contractor in South Bend, IN
• Providers in South Bend, IN by specialty
• Contractor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.