1528104510 NPI number — BONE AND JOINT INSTITUTE OF SOUTH GEORGIA, P.C.

Table of content: (NPI 1528104510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528104510 NPI number — BONE AND JOINT INSTITUTE OF SOUTH GEORGIA, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BONE AND JOINT INSTITUTE OF SOUTH GEORGIA, P.C.
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:
1528104510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1334
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JESUP
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31598-1334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-427-0800
Provider Business Mailing Address Fax Number:
912-810-5556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 PROFESSIONAL CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JESUP
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31545-0044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-427-0800
Provider Business Practice Location Address Fax Number:
912-427-6029
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VALOSEN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
MATTHEW
Authorized Official Title or Position:
OWNER/ SURGEON
Authorized Official Telephone Number:
912-427-0800

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  030633 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003151448B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003151448C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003152097D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100002585A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003134292K , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100002585C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100002585D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002374132D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1648245 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 692353788B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002374132B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003152097C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003274130B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003274130C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002374132A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002374132C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003134292J , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003274130AG , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 676978 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 692353788C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com