1093755266 NPI number — HETLEVIA R VILAR-JENSEN M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093755266 NPI number — HETLEVIA R VILAR-JENSEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILAR-JENSEN
Provider First Name:
HETLEVIA
Provider Middle Name:
R
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:
JENSEN
Provider Other First Name:
HETLEVIA
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1093755266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11457
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-4005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-733-0313
Provider Business Mailing Address Fax Number:
405-733-0140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WETUMKA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74883-4015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-452-5400
Provider Business Practice Location Address Fax Number:
405-452-3000
Provider Enumeration Date:
06/07/2006

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: 207Q00000X , with the licence number:  23895 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200031400B . This is a "SOONERCARE-INDIVIDUAL" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 200031400A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com