1558740019 NPI number — DR. WILLIAM JENNINGS AMADOR D.O.

Table of content: DR. WILLIAM JENNINGS AMADOR D.O. (NPI 1558740019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558740019 NPI number — DR. WILLIAM JENNINGS AMADOR D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMADOR
Provider First Name:
WILLIAM
Provider Middle Name:
JENNINGS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1558740019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
VIA BERTOLISSI, 17C
Provider Second Line Business Mailing Address:
APT A8
Provider Business Mailing Address City Name:
SACILE
Provider Business Mailing Address State Name:
PORDENONE
Provider Business Mailing Address Postal Code:
33077
Provider Business Mailing Address Country Code:
IT
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVIANO HEALTH AND WELLNESS CENTER
Provider Second Line Business Practice Location Address:
AVIANO AIR BASE
Provider Business Practice Location Address City Name:
AVIANO
Provider Business Practice Location Address State Name:
PORDENONE
Provider Business Practice Location Address Postal Code:
33081
Provider Business Practice Location Address Country Code:
IT
Provider Business Practice Location Address Telephone Number:
314-632-5428
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/29/2015

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: 390200000X , with the licence number:  OT016301 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: OS019208 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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