1801874243 NPI number — JANET E THEBY MD

Table of content: JANET E THEBY MD (NPI 1801874243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801874243 NPI number — JANET E THEBY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THEBY
Provider First Name:
JANET
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1801874243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2707 W EDGEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEFFERSON CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65109-5888
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-635-0233
Provider Business Mailing Address Fax Number:
573-635-7436

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2707 W EDGEWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65109-5888
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-635-0233
Provider Business Practice Location Address Fax Number:
573-635-7436
Provider Enumeration Date:
01/05/2006

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: 207Q00000X , with the licence number:  105073 , 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: 1196653 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 206878258 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 508069101 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 241056 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: B08074 . This is a "MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: CH5818 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080193832 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 44 0546366 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 501607808 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25147 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: CD6730 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00099221 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 206878233 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 206878241 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4640661 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 500383609 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: CK7821 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080187712 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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