1750383170 NPI number — DR. JEFFREY L ST JOHN M.D.

Table of content: DR. JEFFREY L ST JOHN M.D. (NPI 1750383170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750383170 NPI number — DR. JEFFREY L ST JOHN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ST JOHN
Provider First Name:
JEFFREY
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1750383170
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
777 NORTH ST STE 203
Provider Second Line Business Mailing Address:
P.O. BOX 1264
Provider Business Mailing Address City Name:
PITTSFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01201-4123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-499-8590
Provider Business Mailing Address Fax Number:
413-499-6410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
777 NORTH ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
PITTSFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01201-4147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-499-8590
Provider Business Practice Location Address Fax Number:
413-499-6410
Provider Enumeration Date:
08/15/2005

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: 207RG0100X , with the licence number:  231178 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2146568 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000043487 . This is a "BMC HEALTHNET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 02635367 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: J41872 . This is a "BCBSMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA96200 . This is a "HARVARD PILGRIM HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1750383170 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7903586 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3002785 . This is a "MVP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 41385 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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