1285650838 NPI number — JACQUES PAPAZIAN M.D,S.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285650838 NPI number — JACQUES PAPAZIAN M.D,S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACQUES PAPAZIAN M.D,S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1285650838
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4117 S WATER TOWER PL
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62864-6567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-242-0672
Provider Business Mailing Address Fax Number:
618-242-0862

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4117 S WATER TOWER PL
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62864-6293
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-242-0672
Provider Business Practice Location Address Fax Number:
618-242-0862
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PAPAZIAN
Authorized Official First Name:
JACQUES
Authorized Official Middle Name:
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
618-242-0672

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  036093598 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 293973 . This is a "HEALTHLINK PROVIDER ID#" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 55563 . This is a "GHP PROVIDER ID#" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 04127654 . This is a "BCBS OF IL PROVIDER#" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036093598 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040009944 . This is a "RAILROAD MEDICARE ID#" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 027794 . This is a "HEALTH ALLIANCE ID#" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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