1942444757 NPI number — DR JARED GAINES MD PA

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 1942444757 NPI number — DR JARED GAINES MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR JARED GAINES MD PA
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:
NORTH FLORIDA FAMILY PSYCHIATRY
Provider Other Organization Name Type Code:
3
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:
1942444757
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1555 KINGSLEY AVE BLDG 300
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
ORANGE PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32073-4560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-284-4216
Provider Business Mailing Address Fax Number:
866-681-5094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1555 KINGSLEY AVE BLDG 300
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
ORANGE PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32073-4560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-284-4216
Provider Business Practice Location Address Fax Number:
866-681-5094
Provider Enumeration Date:
04/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GAINES
Authorized Official First Name:
JARED
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
352-284-4216

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00760459 . This is a "RR MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com