MRS. LISA NAN BOOTH (NPI# 1063447753) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063447753 |
| Entity Type | Individual |
| Full Name | MRS. LISA NAN BOOTH |
| Credential | MD |
| Practice Address |
207 N Townline Rd Ste 104 Lagrange IN 46761-1325 |
| Mailing Address |
3702 New Vision Dr Fort Wayne IN 46845-1703 |
| Practice Telephone | 2604639360 |
| Practice Fax Number | 2604639374 |
| Mailing Telephone | 2602668210 |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2019-02-15 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 01041550 | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | ANTHEM | 000000679262 | 01 |
| IN | 100468460 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346646445 | Lisa Booth | Dietitian, Registered | 25 Rausch St, San Francisco, CA 94103-3917 | 2014-11-17 |
| 1295006872 | Lisa Michelle Booth | Developmental Therapist | 9409 E 65th St, Raytown, MO 64133-4920 | 2012-01-13 |
| 1447755194 | Lisa Elisofon Booth | Behavior Technician | 8815 Columbia 100 Pkwy Ste 4, Columbia, MD 21045-2361 | 2018-03-26 |
| 1306248182 | Lisa Dawn Booth | Nurse Practitioner | 1673 N Royal St, Jackson, TN 38301-3607 | 2014-09-23 |
| Street Address |
207 N TOWNLINE RD STE 104 |
| City | LAGRANGE |
| State | IN |
| Zip Code | 46761-1325 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134184781 | Michael W Conway | Family Medicine | 207 N Townline Rd Ste 104, Lagrange, IN 46761 | 2006-04-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962049007 | Darlene L. Schlotterback | Physical Therapist | 207 N. Townline Rd, Lagrange, IN 46761 | 2019-12-09 |
| 1083264006 | Kimberly A Hershberger | Pharmacist | 0975 N 00 Ew, Lagrange, IN 46761 | 2019-09-12 |
| 1134775554 | Kristy Jo Roth | Pharmacist | 0975n 00 Ew, Lagrange, IN 46761 | 2019-08-12 |
| 1235372277 | Lagrange Surgery Center, LLC | Clinic/Center | 2500 Ventura Way, Lagrange, IN 46761 | 2009-04-07 |
| 1568565265 | Hook Superx LLC | Pharmacy | 975n Ooew, Lagrange, IN 46761 | 2006-09-07 |
| 1558305326 | Craig L Nelson Dds Inc | Dentist | 405 Union Street, Lagrange, IN 46761 | 2006-06-15 |
| 1548220544 | Millard Reed Taylor | Family Medicine | 2120 N Detroit St, Lagrange, IN 46761 | 2006-03-24 |
| 1891791414 | Larry Best | Podiatrist | 400 1/2 Union Street, Lagrange, IN 46761 | 2005-06-28 |
| 1972140010 | Vickie L. Pletcher | Physical Therapy Assistant | 207 N. Townline Rd., Lagrange, IN 46761 | 2019-12-09 |
| 1881231272 | Robert Dean Kinsey | Physical Therapy Assistant | 207 N. Townline Rd., Lagrange, IN 46761 | 2019-12-04 |
| Find all providers in zip 46761 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992153548 | Hometown Physician Group, LLC | Family Medicine | 1698 Vernon Rd, Lagrange, GA 30240-4100 | 2016-05-24 |
| 1073834404 | Robert Ambrose Martin | Family Medicine | 380 S Davis Rd, Suite E&f, Lagrange, GA 30241-2588 | 2010-06-21 |
| 1821228255 | Olumide Adeniyl Ajayi | Family Medicine | 1497 Lafayette Pkwy, Lagrange, GA 30241-2552 | 2009-07-20 |
| 1124201249 | Lagrange Family Medicine | Family Medicine | 303 Medical Dr, Ste 406, Lagrange, GA 30240-4169 | 2007-12-12 |
| 1326181694 | Marcia D. Ebbs Md Psc | Family Medicine | 1009 New Moody Ln, Suite 4, Lagrange, KY 40031-9142 | 2007-02-15 |
| 1043318355 | Lagrange Med Center, LLC | Family Medicine | 309 Vernon St, Lagrange, GA 30240-3162 | 2006-09-20 |
| 1912932617 | Rhonda L Sharp | Family Medicine | 2600 N Detroit St, Lagrange, IN 46761-1154 | 2006-07-11 |
| 1750338968 | Srinivas R Bramhadevi | Family Medicine | 1497 Lafayette Street, Lagrange, GA 30241-2552 | 2006-05-31 |
| 1134184781 | Michael W Conway | Family Medicine | 207 N Townline Rd Ste 104, Lagrange, IN 46761 | 2006-04-18 |
| 1548220544 | Millard Reed Taylor | Family Medicine | 2120 N Detroit St, Lagrange, IN 46761 | 2006-03-24 |
| Find all providers in LAGRANGE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.