Otis D Lyles Jr.

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

Practice address

305 Lynn Dr
Alton, IL 62002-7508

Phone

(314) 581-7735

Fax

(618) 466-5501

NPI assigned

Apr 18, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

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": "1555545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555545600000",
    "number": "1609439272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 LYNN DR",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620027508",
            "telephone_number": "314-581-7735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 LYNN DR",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620027508",
            "telephone_number": "314-581-7735",
            "fax_number": "618-466-5501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1999 Old Jamestown Rd",
            "address_purpose": "LOCATION",
            "city": "Florissant",
            "state": "MO",
            "postal_code": "630336303",
            "country_code": "US",
            "telephone_number": "314-581-7735",
            "fax_number": "618-466-5501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LYLES",
        "first_name": "OTIS",
        "middle_name": "D",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-18",
        "last_updated": "2019-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Non-emergency Medical Transport (VAN) in Alton, IL
• Providers in Alton, IL by specialty
• Non-emergency Medical Transport (VAN) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2019; 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.