1487981064 NPI number — JACOB WAYNE TOWNSEND CPO

Table of content: JACOB WAYNE TOWNSEND CPO (NPI 1487981064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487981064 NPI number — JACOB WAYNE TOWNSEND CPO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOWNSEND
Provider First Name:
JACOB
Provider Middle Name:
WAYNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPO
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:
1487981064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
660 W LINCOLN HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EXTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19341-2514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-337-2277
Provider Business Mailing Address Fax Number:
717-337-3140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 WALDEN RIDGE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-252-0331
Provider Business Practice Location Address Fax Number:
828-252-9764
Provider Enumeration Date:
11/03/2009

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: 222Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1487981064 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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