1114018728 NPI number — JIMMIE G BILES JR. M.D.

Table of content: JIMMIE G BILES JR. M.D. (NPI 1114018728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114018728 NPI number — JIMMIE G BILES JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BILES
Provider First Name:
JIMMIE
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
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:
1114018728
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 LINDSAY LANE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CODY
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82414-4103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-578-1953
Provider Business Mailing Address Fax Number:
307-578-1956

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 LINDSAY LANE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CODY
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-578-1945
Provider Business Practice Location Address Fax Number:
307-578-1956
Provider Enumeration Date:
09/27/2006

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: 207X00000X , with the licence number:  3909A , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200009940 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 102410800 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 302474 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: MD323WY , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 179164 . This is a "WORKER COMP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 297555 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3505047 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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