1427590918 NPI number — THIERRY JACQUEMIN D.O., P.A

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427590918 NPI number — THIERRY JACQUEMIN D.O., P.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THIERRY JACQUEMIN D.O., P.A
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1427590918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3850 BIRD RD
Provider Second Line Business Mailing Address:
SUITE # 501
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33146-1501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-667-1511
Provider Business Mailing Address Fax Number:
305-503-8955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3850 BIRD RD
Provider Second Line Business Practice Location Address:
SUITE # 501
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33146-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-667-1511
Provider Business Practice Location Address Fax Number:
305-503-8955
Provider Enumeration Date:
11/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
JACQUEMIN
Authorized Official First Name:
THIERRY
Authorized Official Middle Name:
O
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
305-667-1511

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  OS9856 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: BS88ST . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1750407086 . This is a "NPI INDIVIDUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 001536700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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