1316154263 NPI number — THE SALVATION ARMY

Table of content: DR. JESUS OLDBURY TAMAYO DO (NPI 1033911417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316154263 NPI number — THE SALVATION ARMY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE SALVATION ARMY
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:
6
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:
1316154263
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX C-635
Provider Second Line Business Mailing Address:
440 WEST NYACK ROAD
Provider Business Mailing Address City Name:
WEST NYACK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10994-1739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-620-7330
Provider Business Mailing Address Fax Number:
845-620-7753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
228 W HUBERT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43130-4712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-687-1921
Provider Business Practice Location Address Fax Number:
740-687-1928
Provider Enumeration Date:
05/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
D
Authorized Official Title or Position:
ASSISTANT SECRETARY
Authorized Official Telephone Number:
845-620-7330

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251V00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0790461 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2677616 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".