1376559807 NPI number — DR. JIM GUO D.C.

Table of content: DR. JIM GUO D.C. (NPI 1376559807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376559807 NPI number — DR. JIM GUO D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUO
Provider First Name:
JIM
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1376559807
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
668 NEWPORT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH ATTLEBORO
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02703-5625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-399-8880
Provider Business Mailing Address Fax Number:
508-399-8881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
668 NEWPORT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH ATTLEBORO
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02703-5625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-399-8880
Provider Business Practice Location Address Fax Number:
508-399-8881
Provider Enumeration Date:
08/01/2006

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:  2262 , 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: Y36582 . This is a "BCBSMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y39931 . This is a "BCBSMA GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 29905 . This is a "BCBSRI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1376763383 . This is a "NPI FED ID ACUPUNCTURE CH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 404715 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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