1881886125 NPI number — MRS. JANIECE LEA GOLDSMITH MSPS

Table of content: MRS. JANIECE LEA GOLDSMITH MSPS (NPI 1881886125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881886125 NPI number — MRS. JANIECE LEA GOLDSMITH MSPS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDSMITH
Provider First Name:
JANIECE
Provider Middle Name:
LEA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSPS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLTZ
Provider Other First Name:
JANIECE
Provider Other Middle Name:
LEA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881886125
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 145
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAOLI
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-207-8544
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 MARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAOLI
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-207-8544
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2007

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: 101YP2500X , with the licence number:  4665 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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