1003888249 NPI number — JANE A WINE

Table of content: (NPI 1003888249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003888249 NPI number — JANE A WINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JANE A WINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JUST YOU
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003888249
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1103 S ZANE HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARTINS FERRY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43935-1967
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-633-2944
Provider Business Mailing Address Fax Number:
740-633-2873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1103 S ZANE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTINS FERRY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43935-1967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-633-2944
Provider Business Practice Location Address Fax Number:
740-633-2873
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WINE
Authorized Official First Name:
JANE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
740-633-2944

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1003888249 . This is a "ANTHEM BCBS OF OHIO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000227413 . This is a "MOUNTAIN STATE BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 220507 . This is a "HEALTH AMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000156188 . This is a "ANTHEM BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: DME703A . This is a "HEALTH PLAN UPPER OV" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1388109 . This is a "UMWA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0832648 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1003888249 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0146900000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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