1730330762 NPI number — ROBERT J JAUCH, MD

Table of content: (NPI 1730330762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730330762 NPI number — ROBERT J JAUCH, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT J JAUCH, MD
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:
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:
1730330762
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
714 BREEZY HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST JOHNSBURY
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05819-8882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-748-5126
Provider Business Mailing Address Fax Number:
802-748-1107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
714 BREEZY HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST JOHNSBURY
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05819-8882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-748-5126
Provider Business Practice Location Address Fax Number:
802-748-1107
Provider Enumeration Date:
10/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JAUCH
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
802-748-5126

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  420006154 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 237600000X , with the licence number: 008425846 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: VT7982 . This is a "MEDICARE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 04PO12 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 0925477 . This is a "CIGNA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 0100833Y0VT01 . This is a "ANTHEM NEW HAMPSHIRE BLUE SHIELD" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 99007982 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0007982 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1047982 . This is a "VERMONT BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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