1972796472 NPI number — JAMESON MEDICAL CARE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972796472 NPI number — JAMESON MEDICAL CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMESON MEDICAL CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1972796472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14397
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POLAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44514-7397
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-758-2775
Provider Business Mailing Address Fax Number:
330-758-2787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1211 WILMINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16105-2516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-658-9001
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AUBEL
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
724-658-9001

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 002007025 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 002007029 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 002007035 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0011868740001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002007032 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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