1295870830 NPI number — PAUL D JAYACHANDRA M D P A

Table of content: (NPI 1295870830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295870830 NPI number — PAUL D JAYACHANDRA M D P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAUL D JAYACHANDRA M D P A
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:
1295870830
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1680 OSCEOLA ELEMENTARY SCHOOL ROAD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
ST AUGUSTINE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32084
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-824-7476
Provider Business Mailing Address Fax Number:
904-824-7870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1680 OSCEOLA ELEMENTARY SCHOOL ROAD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ST AUGUSTINE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-824-7476
Provider Business Practice Location Address Fax Number:
904-824-7870
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FAIRCLOTH
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
RAE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
904-824-7476

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME0066989 , 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: 26220 . This is a "BCBS FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 26220Y . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5777008 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 94163841 . This is a "WAUSA BENIFITS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: AA919 . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 206068 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 376531801 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 390006717 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 110132302 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 26220Y . This is a "MEDICARE PTAN NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 150095 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 150095 . This is a "HEALTHEASE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 376531800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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