1932125093 NPI number — JAY M WILKINS MD

Table of content: JAY M WILKINS MD (NPI 1932125093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932125093 NPI number — JAY M WILKINS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILKINS
Provider First Name:
JAY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1932125093
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 CORPORATE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAVER DAM
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53916-3115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-887-1151
Provider Business Mailing Address Fax Number:
920-887-3353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 CORPORATE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVER DAM
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53916-3115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-887-1151
Provider Business Practice Location Address Fax Number:
920-887-3353
Provider Enumeration Date:
07/14/2006

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: 207W00000X , with the licence number:  46586 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00134868 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: WI0120 . This is a "JOHN DEERE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 391156156 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3457900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39115615618 . This is a "UNITY HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13792 . This is a "DEAN CARE HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 46250 . This is a "NETWORK HEALTH PLAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 2001237 . This is a "PHYSICIANS PLUS HMO" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com