1386811784 NPI number — JAMIE F MEYERS, DDS, MD, PA

Table of content: (NPI 1386811784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386811784 NPI number — JAMIE F MEYERS, DDS, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMIE F MEYERS, DDS, MD, PA
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:
EAST TEXAS FACIAL AND ORAL SURGERY CENTER
Provider Other Organization Name Type Code:
5
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:
1386811784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1721 S SYCAMORE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALESTINE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75801-6921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-723-5111
Provider Business Mailing Address Fax Number:
903-723-0328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1721 S SYCAMORE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALESTINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75801-6921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-723-5111
Provider Business Practice Location Address Fax Number:
903-723-0328
Provider Enumeration Date:
05/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MEYERS
Authorized Official First Name:
JAMIE
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT/PHYSICIAN
Authorized Official Telephone Number:
903-723-5111

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  J3856 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00L19H . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 034546401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 859955 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: G60231 . This is a "CHIPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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