1780699140 NPI number — JIM B SPEARS, INC.

Table of content: (NPI 1780699140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780699140 NPI number — JIM B SPEARS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JIM B SPEARS, INC.
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:
FAMILY PHARMACY, VITAL CARE OF VERNON
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:
1780699140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1720 HILLCREST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERNON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76384-4099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-552-2999
Provider Business Mailing Address Fax Number:
940-552-5347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1720 HILLCREST DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERNON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76384-4099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-552-2999
Provider Business Practice Location Address Fax Number:
940-552-5347
Provider Enumeration Date:
07/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SPEARS
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
940-552-2999

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 16832 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X , with the licence number: 16832 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 16832 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 16832 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 16832 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 16832 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: 16832 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 16832 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0002X , with the licence number: 16832 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 16832 , 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: 100814040A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100814040B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 261308 . This is a "LOCAL MEDICARE PART B" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 148171 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0167199-04 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016719902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000506809 . This is a "BCBS, CROSSOVER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".