1073540266 NPI number — DR. VIKAS MAJITHIA MD

Table of content: DR. VIKAS MAJITHIA MD (NPI 1073540266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073540266 NPI number — DR. VIKAS MAJITHIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAJITHIA
Provider First Name:
VIKAS
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
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:
1073540266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4500 SAN PABLO RD S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32224-1865
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-953-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 NORTH STATE STREET
Provider Second Line Business Practice Location Address:
DEPARTMENT OF MEDICINE/DIVISION OF RHEUMATOLOGY
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39216-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-984-5540
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2006

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: 207RR0500X , with the licence number:  17466 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RR0500X , with the licence number: ME153301 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00127031 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 166559 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1507067 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112847700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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