1144232604 NPI number — JODI L KNOTT DC

Table of content: JODI L KNOTT DC (NPI 1144232604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144232604 NPI number — JODI L KNOTT DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNOTT
Provider First Name:
JODI
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

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:
1144232604
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
136 SILVER MEADOW CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AIKEN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29803-1655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-834-0450
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
258 EASTGATE DR UNIT 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIKEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29803-7698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-373-5383
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2006

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: 111N00000X , with the licence number:  X006504 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5185026 . This is a "AETNA/US HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P938436 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: C06504 . This is a "WORKERS COMP." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: C06504 . This is a "NY NO FAULT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 129047 . This is a "ACN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 856310 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: X6R341 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5897704 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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