1841441193 NPI number — MRS. JEAN T.S. FEICK CNP, CDE

Table of content: GEORGE HEADING MD (NPI 1548364532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841441193 NPI number — MRS. JEAN T.S. FEICK CNP, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEICK
Provider First Name:
JEAN
Provider Middle Name:
T.S.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNP, CDE
Provider Gender Code:
F

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:
1841441193
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1031 PIERCE STREET
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
SANDUSKY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-557-5541
Provider Business Mailing Address Fax Number:
419-557-5542

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 HAYES AVE
Provider Second Line Business Practice Location Address:
DIABETES CLINIC
Provider Business Practice Location Address City Name:
SANDUSKY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44870-3323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-557-6990
Provider Business Practice Location Address Fax Number:
419-621-2202
Provider Enumeration Date:
10/06/2008

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: 163WD0400X , with the licence number:  RN127264 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: NP10121 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00752833 . This is a "MEDICARE RR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2953031 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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