1790769305 NPI number — MARGARET E JANSSEN M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790769305 NPI number — MARGARET E JANSSEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JANSSEN
Provider First Name:
MARGARET
Provider Middle Name:
E
Provider Name Prefix Text:
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:
1790769305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20452
Provider Second Line Business Mailing Address:
FML- CREDENTIALING
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43220-0452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-442-2406
Provider Business Mailing Address Fax Number:
614-442-2410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 W 32ND ST BLDG B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64804-1528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-623-6330
Provider Business Practice Location Address Fax Number:
417-623-3950
Provider Enumeration Date:
12/06/2005

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: 207ZP0102X , with the licence number:  R7E27 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 700432206 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20018352 . This is a "TRAVELERS" identifier . This identifiers is of the category "OTHER".




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