1497313803 NPI number — DR. JACOB WARD SNOWDIN DO

Table of content: DR. JACOB WARD SNOWDIN DO (NPI 1497313803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497313803 NPI number — DR. JACOB WARD SNOWDIN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SNOWDIN
Provider First Name:
JACOB
Provider Middle Name:
WARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1497313803
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776982
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-6982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-494-5797
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1675 LEAHY ST
Provider Second Line Business Practice Location Address:
STE 301A
Provider Business Practice Location Address City Name:
MUSKEGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-672-8300
Provider Business Practice Location Address Fax Number:
231-672-8310
Provider Enumeration Date:
05/31/2019

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: 207RI0200X , with the licence number:  5101028223 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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