1265420400 NPI number — JAMES EMERSON JENKS M.D.

Table of content: BRITTANY CARNAHAN FNP-C (NPI 1841801370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265420400 NPI number — JAMES EMERSON JENKS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENKS
Provider First Name:
JAMES
Provider Middle Name:
EMERSON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1265420400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 471
Provider Second Line Business Mailing Address:
2233 STATE ROUTE 86, ADIRONDACK MEDICAL CENTER
Provider Business Mailing Address City Name:
SARANAC LAKE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12983-5644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-891-4141
Provider Business Mailing Address Fax Number:
518-891-7601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 STETSON AVENUE
Provider Second Line Business Practice Location Address:
TUPPER LAKE HEALTH CENTER
Provider Business Practice Location Address City Name:
TUPPER LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12986-2014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-359-7000
Provider Business Practice Location Address Fax Number:
518-359-8243
Provider Enumeration Date:
10/12/2005

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: 207V00000X , with the licence number:  138704 , 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: 00907608 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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