1962466797 NPI number — DR. THOMAS JOSEPH JENNINGS MD

Table of content: DR. THOMAS JOSEPH JENNINGS MD (NPI 1962466797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962466797 NPI number — DR. THOMAS JOSEPH JENNINGS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENNINGS
Provider First Name:
THOMAS
Provider Middle Name:
JOSEPH
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:
1962466797
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 HOSPITAL DR
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
CORSICANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-654-1171
Provider Business Mailing Address Fax Number:
903-654-1849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
CORSICANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-215-1999
Provider Business Practice Location Address Fax Number:
214-379-1849
Provider Enumeration Date:
04/17/2006

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: 207W00000X , with the licence number:  N3760 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 383311970100 . This is a "COMMUNITY CHOICE MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0110107 . This is a "BCBSM MEDICARE ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 329013810 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0809937 . This is a "SECURE HORIZON DIRECT" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1801101071 . This is a "BLUE CROSS BLUE SHIELD MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0110107 . This is a "MEDICARE PLUS BLUE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1014313 . This is a "BERRIEN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 180027174 . This is a "RR MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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