1295821585 NPI number — ANUJ JAIN M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295821585 NPI number — ANUJ JAIN M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

JAIN

Provider First Name:

ANUJ

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1295821585

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/15/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 6607

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

LINCOLN

Provider Business Mailing Address State Name:

NE

Provider Business Mailing Address Postal Code:

68506-0607

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

402-483-3333

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1600 S 48TH ST STE 600

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

LINCOLN

Provider Business Practice Location Address State Name:

NE

Provider Business Practice Location Address Postal Code:

68506-1275

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

402-483-3333

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

10/05/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0000X , with the licence number:  20428 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0567552 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 47070592301 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 47070592302 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 47070592305 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 47070592306 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 10026072200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 10026072400 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 10026072000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 100411840A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
• Identifier: 10026072300 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 10026072600 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 47070592300 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 47070592313 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 10026072500 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".