1801972518 NPI number — DR. JEFFREY D NEIDHART MD

Table of content: DR. JEFFREY D NEIDHART MD (NPI 1801972518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801972518 NPI number — DR. JEFFREY D NEIDHART MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEIDHART
Provider First Name:
JEFFREY
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1801972518
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1799
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-564-6850
Provider Business Mailing Address Fax Number:
505-564-6890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2325 E 30TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87401-8900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-564-6850
Provider Business Practice Location Address Fax Number:
505-564-6890
Provider Enumeration Date:
10/27/2006

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: 207RH0003X , with the licence number:  2002-0176 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 38022222 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 93002840 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: NM019A39 . This is a "BLUE CROSS OF NEW MEXICO" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: T0445 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 764086 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com