1841357530 NPI number — JENNIFER LYNN SOMERS DPM

Table of content: JENNIFER LYNN SOMERS DPM (NPI 1841357530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841357530 NPI number — JENNIFER LYNN SOMERS DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOMERS
Provider First Name:
JENNIFER
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1841357530
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6483 CITATION DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
CLARKSTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48346-2994
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-751-1025
Provider Business Mailing Address Fax Number:
248-922-9368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6483 CITATION DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CLARKSTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48346-2994
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-751-1025
Provider Business Practice Location Address Fax Number:
248-922-9368
Provider Enumeration Date:
01/02/2007

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: 213ES0103X , with the licence number:  5901002185 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1841357530 . This is a "TRICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 480E015590 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4977980 . This is a "TOTAL HEALTH CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 135073500 . This is a "WORKER COMPENSATION" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 811546797 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00405158 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4977980 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5901002185 . This is a "STATE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 160088 . This is a "GREAT LAKES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4977980 . This is a "OMNICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 6U5660 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7840927 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DB8851 . This is a "RAIL ROAD MEDICARE GRP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0E06293 . This is a "MEDICARE GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4855010950 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com