1780079608 NPI number — MRS. JEANNA J BATESON PA

Table of content: MRS. JEANNA J BATESON PA (NPI 1780079608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780079608 NPI number — MRS. JEANNA J BATESON PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BATESON
Provider First Name:
JEANNA
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARLAND
Provider Other First Name:
JEANNA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780079608
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BOX 3886 DUMC
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27710-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-684-6721
Provider Business Mailing Address Fax Number:
919-681-7085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 ERWIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-684-6721
Provider Business Practice Location Address Fax Number:
919-681-7085
Provider Enumeration Date:
03/30/2015

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: 363A00000X , with the licence number:  0110004975 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 0010-07904 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1780079608 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01546221 . This is a "RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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