1861588923 NPI number — MISS JENNIFER K ROSS BCHIS

Table of content: MISS JENNIFER K ROSS BCHIS (NPI 1861588923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861588923 NPI number — MISS JENNIFER K ROSS BCHIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSS
Provider First Name:
JENNIFER
Provider Middle Name:
K
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
BCHIS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSS-LANDER
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
KAMAHELE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1861588923
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 HARMON LOOP RD
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
DEDEDO
Provider Business Mailing Address State Name:
GU
Provider Business Mailing Address Postal Code:
96929-6536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
671-637-4327
Provider Business Mailing Address Fax Number:
671-637-7018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 HARMON LOOP RD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
DEDEDO
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96929-6536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-637-4327
Provider Business Practice Location Address Fax Number:
671-637-7018
Provider Enumeration Date:
10/05/2006

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: 237700000X , with the licence number:  HA 60221924 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237700000X , with the licence number: 30-201100718-001 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 164 , issued by the state of ( GU ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2R027 . This is a "MEDICAID SAIPAN" identifier . This identifiers is of the category "OTHER".