1407846850 NPI number — JAY R BISHOP D.O.

Table of content: JAY R BISHOP D.O. (NPI 1407846850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407846850 NPI number — JAY R BISHOP D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BISHOP
Provider First Name:
JAY
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1407846850
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 W COUNTRY CLUB RD
Provider Second Line Business Mailing Address:
SUITE #205
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88201-5205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-622-7593
Provider Business Mailing Address Fax Number:
575-622-5538

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 W COUNTRY CLUB RD
Provider Second Line Business Practice Location Address:
SUITE#205
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88201-5205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-622-7593
Provider Business Practice Location Address Fax Number:
575-622-5538
Provider Enumeration Date:
10/26/2005

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: 208800000X , with the licence number:  46011 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: A-1577-10 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 390807236AE . This is a "UNITY" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 13590 . This is a "DEAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: NPI & TIN# . This is a "BCBS OF NM" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: WI01K8 . This is a "JOHN DEERE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: P00061174 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 43509400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00040021 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 46011 . This is a "TOUCHPOINT" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com