1841293941 NPI number — DR. JESSE J JENKINS III MD

Table of content: DR. JESSE J JENKINS III MD (NPI 1841293941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841293941 NPI number — DR. JESSE J JENKINS III MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENKINS
Provider First Name:
JESSE
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1841293941
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
262 DANNY THOMAS PL
Provider Second Line Business Mailing Address:
MAIL STOP 250
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38105-3678
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-595-6304
Provider Business Mailing Address Fax Number:
901-595-3100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
262 DANNY THOMAS PL
Provider Second Line Business Practice Location Address:
MAIL STOP 250
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38105-3678
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-595-6304
Provider Business Practice Location Address Fax Number:
901-595-3100
Provider Enumeration Date:
05/23/2005

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: 207ZP0101X , with the licence number:  16483 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0030716 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0527671 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104677796 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200179700A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132315001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2000631 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 422400000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00117968 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0071944 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009912870 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100033050A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 205140304 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3808768 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1429694 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64926843 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7612397 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com