1699740076 NPI number — DR. JACQUELINE K GIVIDEN M.D.

Table of content: DR. JACQUELINE K GIVIDEN M.D. (NPI 1699740076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699740076 NPI number — DR. JACQUELINE K GIVIDEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIVIDEN
Provider First Name:
JACQUELINE
Provider Middle Name:
K
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:
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:
1699740076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2080 W ARLINGTON BLVD STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27834-3770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-752-2140
Provider Business Mailing Address Fax Number:
252-689-6502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2080 W ARLINGTON BLVD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27834-3770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-752-2140
Provider Business Practice Location Address Fax Number:
252-689-6502
Provider Enumeration Date:
02/21/2006

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: 207L00000X , with the licence number:  01060188A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 2020-04712 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200512950 . This is a "MDWISE HOOSIER ALLIANCE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 2684317000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000361232 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000361232 . This is a "UNICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 7100082610 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000361232 . This is a "INDIANA COMPREHENSIVE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000361232 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200512950 . This is a "MANAGED HEALTH SERVICES" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00265884 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000361232 . This is a "HEALTHLINK" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000361232 . This is a "ANTHEM SENIOR ADVANTAGE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000361232 . This is a "ONE NATION BENEFIT" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000361232 . This is a "ANTHEM MEDICAID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200512950 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50009617 . This is a "PASSPORT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 129703800 . This is a "BLACK LUNG PROGRAM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 129703800 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 134960H . This is a "UNICARE MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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