1093908287 NPI number — JONS FAMILY INC.

Table of content: MS. ANNETTE NICOLE MERSHIMER MA (NPI 1477037687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093908287 NPI number — JONS FAMILY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JONS FAMILY INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1093908287
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 257
Provider Second Line Business Mailing Address:
210 N. GARRISON AVE.
Provider Business Mailing Address City Name:
BONESTEEL
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57317-0257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-654-9040
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 N GARRISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BONESTEEL
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57317-0257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-654-9045
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JONS
Authorized Official First Name:
MONICA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
MANAGER/ADMINISTRATOR
Authorized Official Telephone Number:
605-654-9045

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  40097 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9571900 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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