1154436301 NPI number — JENNIFER F EAMES DC

Table of content: JENNIFER F EAMES DC (NPI 1154436301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154436301 NPI number — JENNIFER F EAMES DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EAMES
Provider First Name:
JENNIFER
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

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:
1154436301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 148
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02738-0003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-748-6633
Provider Business Mailing Address Fax Number:
508-748-6649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
238 WAREHAM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02738-1166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-748-6633
Provider Business Practice Location Address Fax Number:
508-748-6649
Provider Enumeration Date:
08/20/2006

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: 111N00000X , with the licence number:  2725 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04C275 . This is a "ACN PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA8569 . This is a "HPHC PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: Y36999 . This is a "BCBS OF MA PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1193767 . This is a "AETNA PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 696220 . This is a "UHC PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 494610 . This is a "TUFTS PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000025416 . This is a "BMC HEALTHNET PROVIDER ID" identifier . This identifiers is of the category "OTHER".




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