1275744864 NPI number — DR. ZEB K HENSON M.D.

Table of content: DR. ZEB K HENSON M.D. (NPI 1275744864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275744864 NPI number — DR. ZEB K HENSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENSON
Provider First Name:
ZEB
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
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:
1275744864
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 NORTH STATE STREET
Provider Second Line Business Mailing Address:
DIVISION OF GENERAL INTERNAL MEDICINE
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39216-4500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-984-5770
Provider Business Mailing Address Fax Number:
601-984-6853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 NORTH STATE STREET
Provider Second Line Business Practice Location Address:
DEPARTMENT OF MEDICINE DIVISION OF INTERNAL MEDICINE
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39216-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-984-5770
Provider Business Practice Location Address Fax Number:
601-984-6853
Provider Enumeration Date:
05/24/2007

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:  19909 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 19909 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2142763 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02930560 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 185909 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01118800 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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