1962483842 NPI number — JAYNE A MINIER M.D.

Table of content: JAYNE A MINIER M.D. (NPI 1962483842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962483842 NPI number — JAYNE A MINIER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MINIER
Provider First Name:
JAYNE
Provider Middle Name:
A
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:
1962483842
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
278 BENEDICT AVE
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
NORWALK
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44857-2721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-668-5222
Provider Business Mailing Address Fax Number:
419-668-5251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
278 BENEDICT AVE
Provider Second Line Business Practice Location Address:
SUITE 800
Provider Business Practice Location Address City Name:
NORWALK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44857-2721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-668-5222
Provider Business Practice Location Address Fax Number:
419-668-5251
Provider Enumeration Date:
11/08/2005

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: 208600000X , with the licence number:  65639 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000121932 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0933191 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020038039 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4263482 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 124594500 . This is a "FEDERAL WORKMANS COMP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1342608 . This is a "FIRST HEALTH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 311571453004 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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