1659395341 NPI number — DR. KAREN L JIMENEZ M.D

Table of content: DR. KAREN L JIMENEZ M.D (NPI 1659395341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659395341 NPI number — DR. KAREN L JIMENEZ M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JIMENEZ
Provider First Name:
KAREN
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JIMENEZ
Provider Other First Name:
KAREN
Provider Other Middle Name:
LORRAINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1659395341
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6701 AIRPORT BLVD STE A101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36608-6767
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-378-6209
Provider Business Mailing Address Fax Number:
251-378-6222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7885 MOFFETT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEMMES
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36575-5487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-660-5840
Provider Business Practice Location Address Fax Number:
251-660-5841
Provider Enumeration Date:
07/26/2006

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: 207R00000X , with the licence number:  00013400 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 051558373 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 510-04615 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".