Provider Demographics
NPI:1669086328
Name:METCALFE, JASON (RPSGT)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:METCALFE
Suffix:
Gender:M
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 TILLERY ST STE 12
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-3751
Mailing Address - Country:US
Mailing Address - Phone:510-996-2688
Mailing Address - Fax:
Practice Address - Street 1:701 TILLERY ST STE 12
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3751
Practice Address - Country:US
Practice Address - Phone:510-996-2688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
19983246Z00000X, 225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
No174H00000XOther Service ProvidersHealth Educator
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
19983OtherBOARD OF POLYSOMNOGRAPHIC TECHNOLOGISTS