1053486118 NPI number — JENNIFER JAYNE LYNCH RIGGS PA

Table of content: JENNIFER JAYNE LYNCH RIGGS PA (NPI 1053486118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053486118 NPI number — JENNIFER JAYNE LYNCH RIGGS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYNCH RIGGS
Provider First Name:
JENNIFER
Provider Middle Name:
JAYNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIGGS
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
LYNCH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1053486118
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30532
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32503-1532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-916-3700
Provider Business Mailing Address Fax Number:
850-916-3710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 GULF BREEZE PKWY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
GULF BREEZE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32561-7809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-916-3700
Provider Business Practice Location Address Fax Number:
850-916-3710
Provider Enumeration Date:
11/22/2006

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: 363A00000X , with the licence number:  PA9102565 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9371395 . This is a "AETNA PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 592-08975 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 59197546 . This is a "BCBS ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 59197955 . This is a "BCBS ALABAMA - GBO" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 114287 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00397341 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: Y01JG . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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