1821091810 NPI number — JAMES L DELINE M.D.

Table of content: JAMES L DELINE M.D. (NPI 1821091810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821091810 NPI number — JAMES L DELINE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELINE
Provider First Name:
JAMES
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DELINE
Provider Other First Name:
JIM
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1821091810
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 MCKAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63552-2029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-385-3141
Provider Business Mailing Address Fax Number:
660-385-5866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 MCKAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63552-2029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-385-3141
Provider Business Practice Location Address Fax Number:
660-385-5866
Provider Enumeration Date:
05/24/2005

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: 207Q00000X , with the licence number:  MD 36425 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: 36425 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 54535 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11794 . This is a "BLUE CROSS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 193025 . This is a "THE FUNDS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431671124DEL . This is a "MERCY HEALTH PLANS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1930156 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 930078535 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010012805 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 252291 . This is a "HEALTHLINK HMO AND PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202144804 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com