1104833755 NPI number — DR. JAMES G SHOWALTER M.D.

Table of content: DR. JAMES G SHOWALTER M.D. (NPI 1104833755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104833755 NPI number — DR. JAMES G SHOWALTER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHOWALTER
Provider First Name:
JAMES
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1104833755
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98431-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
807 LAWN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELLERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18960-1549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-257-6551
Provider Business Practice Location Address Fax Number:
215-257-9347
Provider Enumeration Date:
08/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0804X , with the licence number:  MD036681E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001663460 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: RAILROAD MEDICARE . This is a "260045830" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: SH724972 . This is a "BLUESHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com