1326019613 NPI number — JEFFERY S ADAM MD

Table of content: JEFFERY S ADAM MD (NPI 1326019613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326019613 NPI number — JEFFERY S ADAM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADAM
Provider First Name:
JEFFERY
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1326019613
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3170 KETTERING BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORAINE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45439-1924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-991-3188
Provider Business Mailing Address Fax Number:
937-223-9811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 S STANFIELD RD
Provider Second Line Business Practice Location Address:
STE 304
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45373-2374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-440-7872
Provider Business Practice Location Address Fax Number:
937-440-7874
Provider Enumeration Date:
01/27/2006

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: 207Y00000X , with the licence number:  35.042734 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000003863 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: D42734 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0680759 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0640419 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 290420811006 . This is a "MEDICAL MUTUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1020049 . This is a "UNITEDHEALTHCARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com