1437418340 NPI number — JVL INTERNATIONAL, INC

Table of content: (NPI 1437418340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437418340 NPI number — JVL INTERNATIONAL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JVL INTERNATIONAL, INC
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:
6
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:
1437418340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4606
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROCKTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02303-4606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-510-5720
Provider Business Mailing Address Fax Number:
508-510-4237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 PLEASANT ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
BROCKTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02301-2533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-510-5720
Provider Business Practice Location Address Fax Number:
508-510-4237
Provider Enumeration Date:
05/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LAM
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
VAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-666-4444

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  670 , 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: AA285366 . This is a "HAVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7001000Y61642 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com