1053380360 NPI number — JEFFREY S BARTON D.O.

Table of content: JEFFREY S BARTON D.O. (NPI 1053380360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053380360 NPI number — JEFFREY S BARTON D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTON
Provider First Name:
JEFFREY
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1053380360
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 587
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIPLEY
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25271-0587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-373-0133
Provider Business Mailing Address Fax Number:
304-373-1598

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
122 PINNELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIPLEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25271-9101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-373-0133
Provider Business Practice Location Address Fax Number:
304-373-1598
Provider Enumeration Date:
03/17/2006

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: 208600000X , with the licence number:  34005777B , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: 2316 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 55-0462730 . This is a "TAX-ID" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2107786 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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