1346284007 NPI number — JAMES D DELOACH JR. OT

Table of content: JAMES D DELOACH JR. OT (NPI 1346284007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346284007 NPI number — JAMES D DELOACH JR. OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELOACH
Provider First Name:
JAMES
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
OT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DELOACH
Provider Other First Name:
DOUG
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1346284007
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
790 REMINGTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOLINGBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60440-4909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-296-2222
Provider Business Mailing Address Fax Number:
630-759-9510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
76359 AL HIGHWAY 77
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35096-5039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-296-2222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2006

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: 225X00000X , with the licence number:  0815 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 51526420 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51507914 . This is a "BS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51509009 . This is a "BS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51509034 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51509035 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51524965 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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