1275730194 NPI number — DR. MHAMAD BADRADDIN JIBRINI MD

Table of content: ELBA E ALVARADO MA, AMFT (NPI 1316536568)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275730194 NPI number — DR. MHAMAD BADRADDIN JIBRINI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JIBRINI
Provider First Name:
MHAMAD
Provider Middle Name:
BADRADDIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1275730194
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 636267
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-838-1281
Provider Business Mailing Address Fax Number:
859-838-1239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 LANDMARK DR
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41073-1396
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-838-1281
Provider Business Practice Location Address Fax Number:
859-838-1239
Provider Enumeration Date:
07/03/2007

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:  40854 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 35-092004 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200926710 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2915000 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100063060 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00693655 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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