1093742603 NPI number — DR. JESSICA C MCBETH M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093742603 NPI number — DR. JESSICA C MCBETH M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MCBETH

Provider First Name:

JESSICA

Provider Middle Name:

C

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

COOPER

Provider Other First Name:

JESSICA

Provider Other Middle Name:

S

Provider Other Name Prefix Text:

DR.

Provider Other Name Suffix Text:

Provider Other Credential Text:

MD

Provider Other Last Name Type Code:

1

NPI Number:

1093742603

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/28/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

751 S BASCOM AVE

Provider Second Line Business Mailing Address:

VALLEY MEDICAL CENTER, DEPT OF ORTHOPAEDICS

Provider Business Mailing Address City Name:

SAN JOSE

Provider Business Mailing Address State Name:

CA

Provider Business Mailing Address Postal Code:

95128-2604

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

408-885-5395

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

751 S BASCOM AVE

Provider Second Line Business Practice Location Address:

VALLEY MEDICAL CENTER, DEPT OF ORTHOPAEDICS

Provider Business Practice Location Address City Name:

SAN JOSE

Provider Business Practice Location Address State Name:

CA

Provider Business Practice Location Address Postal Code:

95128-2604

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

408-885-5395

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

06/27/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207X00000X , with the licence number:  47182 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207X00000X , with the licence number: A97096 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0599258 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 00A970960 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
• Identifier: 2372484 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 0148395 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
• Identifier: 951550000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 135301 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 09-02199 . This is a "MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: HP54825 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 09-00027 . This is a "MEDICA PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 1044692 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: E013 . This is a "CHAMPUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".