Provider Demographics
NPI:1932815081
Name:JH ORG 07302014
Entity Type:Organization
Organization Name:JH ORG 07302014
Other - Org Name:SMOKE 04/04
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:TEST
Authorized Official - Middle Name:
Authorized Official - Last Name:ORG-A
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:555-111-2222
Mailing Address - Street 1:7281 4TH ST
Mailing Address - Street 2:
Mailing Address - City:REMINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22734-2124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6801 KENNEDY RD
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20187-3995
Practice Address - Country:US
Practice Address - Phone:324-324-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1835C0206XPharmacy Service ProvidersPharmacistCardiologyGroup - Multi-Specialty
No1835C0207XPharmacy Service ProvidersPharmacistCompounded Sterile PreparationsGroup - Multi-Specialty
No1835E0208XPharmacy Service ProvidersPharmacistEmergency MedicineGroup - Multi-Specialty
No1835I0206XPharmacy Service ProvidersPharmacistInfectious DiseasesGroup - Multi-Specialty
No1835S0206XPharmacy Service ProvidersPharmacistSolid Organ TransplantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTEST
AZSDFSDFMedicaid