1508451287 NPI number — HNMJTS2021 PLLC

Table of content: (NPI 1508451287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508451287 NPI number — HNMJTS2021 PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HNMJTS2021 PLLC
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:
1508451287
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1424 US HIGHWAY 331 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEFUNIAK SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32435-3401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-920-1700
Provider Business Mailing Address Fax Number:
850-520-5357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1424 US HIGHWAY 331 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEFUNIAK SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32435-3401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-201-7008
Provider Business Practice Location Address Fax Number:
850-520-5357
Provider Enumeration Date:
03/04/2021

Additional Information

Authorized Official

Authorized Official Last Name:
JETER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
850-520-5357

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110522200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com