1316943897 NPI number — JANET E SIMON DPM

Table of content: JANET E SIMON DPM (NPI 1316943897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316943897 NPI number — JANET E SIMON DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMON
Provider First Name:
JANET
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1316943897
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4343 PAN AMERICAN FWY NE
Provider Second Line Business Mailing Address:
STE 234
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87107-6834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-880-1000
Provider Business Mailing Address Fax Number:
505-880-1002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8300 CARMEL AVE NE
Provider Second Line Business Practice Location Address:
STE 501
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87122-3125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-797-1001
Provider Business Practice Location Address Fax Number:
505-828-1571
Provider Enumeration Date:
06/21/2005

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: 213ES0103X , with the licence number:  223 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NM005430 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 25842 . This is a "PRESBYTERIAN HEALTH PLAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 000F6176 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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