1528375771 NPI number — JAAP INC

Table of content: MRS. AMY BYARS SANDERS R.P.T. (NPI 1841254836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528375771 NPI number — JAAP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAAP INC
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:
Provider Other Organization Name Type Code:
6
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:
1528375771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4110 MOSEBY ST
Provider Second Line Business Mailing Address:
MAIN EXCHANGE PX
Provider Business Mailing Address City Name:
FORT JACKSON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29207-0614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-790-1849
Provider Business Mailing Address Fax Number:
803-790-1846

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4110 MOSEBY ST
Provider Second Line Business Practice Location Address:
MAIN EXCHANGE PX
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29207-6118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-790-1849
Provider Business Practice Location Address Fax Number:
803-790-1846
Provider Enumeration Date:
09/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CANDELA
Authorized Official First Name:
PETER
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
808-790-1849

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  795 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DO7957 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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