1780673087 NPI number — DR. JENNIFER B POWELL M.D.

Table of content: DR. JENNIFER B POWELL M.D. (NPI 1780673087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780673087 NPI number — DR. JENNIFER B POWELL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWELL
Provider First Name:
JENNIFER
Provider Middle Name:
B
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:
1780673087
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2065 PALOUSE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONDON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43140-9019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-852-6000
Provider Business Mailing Address Fax Number:
740-852-7955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
54 W HIGH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LONDON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43140-1075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-852-6000
Provider Business Practice Location Address Fax Number:
740-852-7955
Provider Enumeration Date:
10/19/2005

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: 207V00000X , with the licence number:  35.084604 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2584289 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000370435 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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