1558425470 NPI number — DR. JENNIFER JOHNSON CALDWELL, MD, PA

Table of content: (NPI 1558425470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558425470 NPI number — DR. JENNIFER JOHNSON CALDWELL, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. JENNIFER JOHNSON CALDWELL, MD, PA
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:
NA
Provider Other Organization Name Type Code:
5
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:
1558425470
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:
2450 LOUISIANA ST
Provider Second Line Business Mailing Address:
400-716
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77006-2380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-520-8963
Provider Business Mailing Address Fax Number:
713-523-6941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1315 ST. JOSEPH'S PARKWAY
Provider Second Line Business Practice Location Address:
#1309
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-654-4493
Provider Business Practice Location Address Fax Number:
713-654-0020
Provider Enumeration Date:
12/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON-CALDWELL
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
LAVETTE
Authorized Official Title or Position:
PRESIDENT PHYSICIAN
Authorized Official Telephone Number:
713-654-4493

Provider Taxonomy Codes

  • Taxonomy code: 207QA0505X , with the licence number:  C23208 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207R00000X , with the licence number: K5571 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 15777101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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