Active NPI
Teddy S Lancaster, M.D.
- Family Medicine Physician
- Walnut Ridge, AR
National Provider Identifier
1366516924
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- C4391
- Practice address
- 1210 W Main St
Walnut Ridge, AR 72476-1005 - Phone
- (870) 886-3543
- Fax
- (870) 886-3252
- NPI assigned
- Nov 17, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | C4391 | AR | Primary |
Addresses
Primary practice location
1210 W Main St
Walnut Ridge, AR 72476-1005
Mailing address
PO Box 719
Walnut Ridge, AR 72476-0719
Phone (870) 886-3543
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 53020 | Other | AR | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C4391 | AR | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1366516924",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 719",
"city": "WALNUT RIDGE",
"state": "AR",
"postal_code": "724760719",
"telephone_number": "870-886-3543",
"fax_number": "870-886-3252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1210 W MAIN ST",
"city": "WALNUT RIDGE",
"state": "AR",
"postal_code": "724761005",
"telephone_number": "870-886-3543",
"fax_number": "870-886-3252"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANCASTER",
"first_name": "TEDDY",
"middle_name": "S",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AR",
"license": "C4391",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "53020",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Walnut Ridge, AR
- Kidspot Learning Center
- Kidspot Walnut Ridge
- Kidspot Walnut Ridge
- Kidspot Walnut Ridge2
- Meaghan Danielle Kingston, APRN
- Lawrence County Chiropractic Clinic, Inc.
- Lawrence County Family Clinic, PA (Lawence County Family Clinic, P.A .,Rural Health Clinic)
- Lawrence County Family Clinic, PA
- Lawrence County School District
- Lawrence Hall Health & Rehabilitation
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.