1346511359 NPI number — MISS JESSICA HOWARD GREENEMEIER PA-C

Table of content: MISS JESSICA HOWARD GREENEMEIER PA-C (NPI 1346511359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346511359 NPI number — MISS JESSICA HOWARD GREENEMEIER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREENEMEIER
Provider First Name:
JESSICA
Provider Middle Name:
HOWARD
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1346511359
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 911230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75391-1230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-997-8000
Provider Business Mailing Address Fax Number:
972-234-2987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3410 WORTH ST
Provider Second Line Business Practice Location Address:
STE 160
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75246-2003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-826-9873
Provider Business Practice Location Address Fax Number:
214-826-2573
Provider Enumeration Date:
01/23/2012

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: 363AS0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 294803602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01043288 . This is a "RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 294803601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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