1952393837 NPI number — DR. RONALD E JAMERSON M.D.

Table of content: DR. RONALD E JAMERSON M.D. (NPI 1952393837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952393837 NPI number — DR. RONALD E JAMERSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAMERSON
Provider First Name:
RONALD
Provider Middle Name:
E
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:
1952393837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/23/2006
NPI Reactivation Date:
03/28/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
757 45TH STREET
Provider Second Line Business Mailing Address:
STE. 201
Provider Business Mailing Address City Name:
MUNSTER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-922-5550
Provider Business Mailing Address Fax Number:
219-922-5555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 U.S. 41
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHEREVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-365-0970
Provider Business Practice Location Address Fax Number:
219-365-1830
Provider Enumeration Date:
08/17/2005

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: 207Y00000X , with the licence number:  01039372 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X , with the licence number: 01039372A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100102610B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2051064 . This is a "AETNA US HEALTH SERVICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5590201001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040012827 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 90000851 . This is a "BCBS OF IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 000000093105 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 352051779001 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".




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