1538276290 NPI number — MRS. JEAN F. POINTON MD

Table of content: DEANNE K BOLHUIS A.R.N.P. (NPI 1184622425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538276290 NPI number — MRS. JEAN F. POINTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POINTON
Provider First Name:
JEAN
Provider Middle Name:
F.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1538276290
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1220 QUEEN CITY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35401-2351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-265-0581
Provider Business Mailing Address Fax Number:
541-574-6252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 SW NYE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97365-3821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-265-4179
Provider Business Practice Location Address Fax Number:
541-265-4194
Provider Enumeration Date:
08/25/2006

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: 2084P0800X , with the licence number:  24771 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: MD160151 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: 70-320 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 443BL . This is a "EMPIRE BCBS PROVIDER #" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051519855 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 0007796548 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051519855 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500651663 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 504900 . This is a "VALUEOPTIONS PROVIDER #" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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