1336117001 NPI number — MRS. JAMIE R TRUELOVE NP

Table of content: MRS. JAMIE R TRUELOVE NP (NPI 1336117001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336117001 NPI number — MRS. JAMIE R TRUELOVE NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRUELOVE
Provider First Name:
JAMIE
Provider Middle Name:
R
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

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:
1336117001
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4131 W LOOMIS RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53221-2059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-325-7246
Provider Business Mailing Address Fax Number:
414-325-3770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4411 WASHINGTON AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47714-0805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-437-7246
Provider Business Practice Location Address Fax Number:
812-401-7246
Provider Enumeration Date:
03/09/2006

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: 363L00000X , with the licence number:  71001429 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DN9587 . This is a "RAILROAD MEDICARE GROUP PTAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P01074995 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000773360 . This is a "ANTHEM PROVIDER ID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200400000 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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