1740441302 NPI number — GEORGETOWN OB GYN LLP

Table of content: (NPI 1740441302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740441302 NPI number — GEORGETOWN OB GYN LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGETOWN OB GYN LLP
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:
JOHN VANEFF SHERMAN MD
Provider Other Organization Name Type Code:
5
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:
1740441302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1223
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78627-1223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-863-8600
Provider Business Mailing Address Fax Number:
512-863-8641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
602 HIGH TECH DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-863-8600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SANTIFER
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
512-863-8600

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  H7653 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: K7214 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00046M . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000866B . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 428883006 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10008667 . This is a "AMERICGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2290118 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0962581 02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21149582824 01 . This is a "BEECHSTREET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3361599 . This is a "BLUE LINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5320762 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00046M . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0058487 . This is a "BLUE LINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2290279 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00L62J . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1235269 03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4393421 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00L62J . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2949121001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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