1518041342 NPI number — JAMESTOWN MEDICAL ONCOLOGY HEMATOLOGY, LLC

Table of content: (NPI 1518041342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518041342 NPI number — JAMESTOWN MEDICAL ONCOLOGY HEMATOLOGY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMESTOWN MEDICAL ONCOLOGY HEMATOLOGY, LLC
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:
JAMESTOWN MEDICAL ONCOLOGY HEMATOLOGY, LLC
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:
1518041342
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMESTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14702-0009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-664-1909
Provider Business Mailing Address Fax Number:
716-664-2214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 PORTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14701-6247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-664-1909
Provider Business Practice Location Address Fax Number:
716-664-2214
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
IBABAO
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
GABUTEN
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
716-664-1909

Provider Taxonomy Codes

  • Taxonomy code: 261QX0200X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11303 . This is a "MAGNACARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040403007130 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02365855 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 714714 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000524493003 . This is a "BCBS OF WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7200341 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000866280 . This is a "MGP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00010352702 . This is a "UNIVERA HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0007232005 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: AA0630 . This is a "MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0191329 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1294660001 . This is a "NHIC DME JURISDICTION A" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CG8430 . This is a "RR MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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