1518916501 NPI number — SHAUN PATRICK JESTER DO

Table of content: SHAUN PATRICK JESTER DO (NPI 1518916501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518916501 NPI number — SHAUN PATRICK JESTER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JESTER
Provider First Name:
SHAUN
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
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:
1518916501
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3420 22ND PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79410-1314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-725-5844
Provider Business Mailing Address Fax Number:
806-723-6532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2241 ROMBACH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45177-1995
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-283-2588
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2006

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: 207V00000X , with the licence number:  OS012463 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 34.008226 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: M3275 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 216985 . This is a "UNITED HEALTHCARE FLEMMIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 217155 . This is a "UNITED HEALTHCARE DEPHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 251860035 . This is a "DEVON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1758602 . This is a "PREMIER BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1758602 . This is a "KEYSTONE HEALTH PLAN WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 251860035 . This is a "HEALTH AMERCIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1758602 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 93462 . This is a "GEISINGER HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 709656 . This is a "UPMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1014529640001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 191443 . This is a "UNITED HEALTHCARE PHILIPS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101452964 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00287679 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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