1750382446 NPI number — MR. JEFFERY HOWARD BARON FNP

Table of content: MR. JEFFERY HOWARD BARON FNP (NPI 1750382446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750382446 NPI number — MR. JEFFERY HOWARD BARON FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARON
Provider First Name:
JEFFERY
Provider Middle Name:
HOWARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1750382446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 REID PKWY
Provider Second Line Business Mailing Address:
MEDICAL STAFF SERVICES
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47374-1157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-983-3127
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
386 SYMMES CENTER DR STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47394-9402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-586-6600
Provider Business Practice Location Address Fax Number:
765-547-6503
Provider Enumeration Date:
08/03/2005

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: 363LF0000X , with the licence number:  71000348A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000296371 . This is a "BC/BS #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200229820 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2293629 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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