1467418103 NPI number — WHITNEY E JAMIE M.D.

Table of content: WHITNEY E JAMIE M.D. (NPI 1467418103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467418103 NPI number — WHITNEY E JAMIE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAMIE
Provider First Name:
WHITNEY
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1467418103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776351
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-6351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-969-6552
Provider Business Mailing Address Fax Number:
502-212-1358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4121 DUTCHMANS LN
Provider Second Line Business Practice Location Address:
SUITE 515
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-899-6907
Provider Business Practice Location Address Fax Number:
502-899-6905
Provider Enumeration Date:
04/21/2006

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: 207VM0101X , with the licence number:  39226 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0305488 . This is a "CIGNA / CMA DBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64104227 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000379510 . This is a "ANTHEM / CMA DBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1223618 . This is a "CHA / CMA DBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50007178 . This is a "PASSPORT / CMA DBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000023031Q . This is a "HUMANA / CMA DBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200540690 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2448350000 . This is a "PASSPORT ADVANTAGE / CMA DBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061453 . This is a "SIHO / CMA DBA" identifier . This identifiers is of the category "OTHER".




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