1538354501 NPI number — JAMIE ANN SIMON PA-C

Table of content: JAMIE ANN SIMON PA-C (NPI 1538354501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538354501 NPI number — JAMIE ANN SIMON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMON
Provider First Name:
JAMIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SEBALD
Provider Other First Name:
JAMIE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538354501
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3875 BAY RD
Provider Second Line Business Mailing Address:
SUITE 1-S
Provider Business Mailing Address City Name:
SAGINAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48603-2417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-892-5664
Provider Business Mailing Address Fax Number:
989-892-0662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3875 BAY RD
Provider Second Line Business Practice Location Address:
SUITE 1-S
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48603-2417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-892-5664
Provider Business Practice Location Address Fax Number:
989-892-0662
Provider Enumeration Date:
09/12/2007

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: 363A00000X , with the licence number:  5601005128 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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