1346243037 NPI number — JASON DOUGLAS WARD P.T.

Table of content: MS. PATSY LENORA SQUIRE (NPI 1972277986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346243037 NPI number — JASON DOUGLAS WARD P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARD
Provider First Name:
JASON
Provider Middle Name:
DOUGLAS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
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:
1346243037
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7730 WOLF RIVER BLVD
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38138-1708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-522-6671
Provider Business Mailing Address Fax Number:
901-522-6715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7730 WOLF RIVER BLVD
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38138-1708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-522-6671
Provider Business Practice Location Address Fax Number:
901-522-6715
Provider Enumeration Date:
05/27/2005

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: 225100000X , with the licence number:  PT6807 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0723280001 . This is a "PALMETTO" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4063289 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: P00314160 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3645189 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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