1255336459 NPI number — DR. JOCELYN FLORENDO SHIMEK D.O.

Table of content: DR. JOCELYN FLORENDO SHIMEK D.O. (NPI 1255336459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255336459 NPI number — DR. JOCELYN FLORENDO SHIMEK D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIMEK
Provider First Name:
JOCELYN
Provider Middle Name:
FLORENDO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1255336459
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9471 MARKET ST
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
NORTH LIMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44452-8702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-729-2388
Provider Business Mailing Address Fax Number:
330-629-6468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
564 E 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
234-567-8150
Provider Business Practice Location Address Fax Number:
234-567-8189
Provider Enumeration Date:
06/15/2005

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: 207R00000X , with the licence number:  34-00-3263S , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0545575 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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