1588104814 NPI number — JACKSON COUNTY PEDIATRIC EXTENDED CARE LLC

Table of content: DR. HARRY RICHARD SCHARF DENTIST (NPI 1245214394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588104814 NPI number — JACKSON COUNTY PEDIATRIC EXTENDED CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACKSON COUNTY PEDIATRIC EXTENDED CARE LLC
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:
1588104814
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8178 SOLDIER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAPHNE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36526-6135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-232-1518
Provider Business Mailing Address Fax Number:
228-206-0704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2025 JACKSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASCAGOULA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39567-4427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-205-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HAMMOND
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
251-232-1518

Provider Taxonomy Codes

  • Taxonomy code: 3140N1450X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com