1295767986 NPI number — XAVIER M. JENKINS M.D.

Table of content: DR. MARK WINTHER M.D. (NPI 1417132358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295767986 NPI number — XAVIER M. JENKINS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENKINS
Provider First Name:
XAVIER
Provider Middle Name:
M.
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:
1295767986
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11315 CORTEZ BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKSVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34613-5407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-592-0220
Provider Business Mailing Address Fax Number:
352-597-4272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11315 CORTEZ BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKSVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34613-5407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-592-0220
Provider Business Practice Location Address Fax Number:
352-597-4272
Provider Enumeration Date:
07/06/2006

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: 208600000X , with the licence number:  ME132241 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00248174 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200258400C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200258400L , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 209182104 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 188387 . This is a "ANTHEM" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 103663200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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