1538167333 NPI number — JMH DIVISIFIED HEALTHCARE

Table of content: (NPI 1538167333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538167333 NPI number — JMH DIVISIFIED HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JMH DIVISIFIED HEALTHCARE
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:
JMH AMBULANCE SERVICE
Provider Other Organization Name Type Code:
3
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:
1538167333
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 279
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FESTUS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63028-0279
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-933-5730
Provider Business Mailing Address Fax Number:
636-933-5301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 HIGHWAY 61
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FESTUS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63028-4100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-933-5730
Provider Business Practice Location Address Fax Number:
636-933-5301
Provider Enumeration Date:
07/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HALLEY
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
636-933-1178

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  099121 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 81 81285 . This is a "MEDICARE COMPLETE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 122373 . This is a "BLUE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1033804 . This is a "CARE PARTNERS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 8229 . This is a "HEALTH CARE USA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 122373 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 241762 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 3329921 . This is a "HEALTH MARKET" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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