NPIMap

Organization Active NPI

Jacques D. Beveridge MD, Inc.

  • Obstetrics & Gynecology Physician
  • Lander, WY
National Provider Identifier
1114057080
Registry record updated Oct 24, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
6275A Issued in WY
Legal business name
JACQUES D. BEVERIDGE MD, INC.
Practice address
1460 Main St
Suite B
Lander, WY 82520-2657
Phone
(307) 332-2223
NPI assigned
Mar 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Frederick J Zebroski
Title
Manager
Phone
(307) 332-2223

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X 6275A WY Primary
Advanced Practice MidwifeGroup: 193200000X MULTI-SPECIALTY GROUP 367A00000X 8746.0044 WY

Addresses

Primary practice location

1460 Main St
Suite B
Lander, WY 82520-2657

Mailing address

1460 Main St
Suite B
Lander, WY 82520-2657
Phone (307) 332-2223

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193184000000",
    "number": "1114057080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1460 MAIN ST",
            "address_2": "SUITE B",
            "city": "LANDER",
            "state": "WY",
            "postal_code": "825202657",
            "telephone_number": "307-332-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 MAIN ST",
            "address_2": "SUITE B",
            "city": "LANDER",
            "state": "WY",
            "postal_code": "825202657",
            "telephone_number": "307-332-2223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACQUES D. BEVERIDGE MD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2007-10-24",
        "status": "A",
        "authorized_official_last_name": "ZEBROSKI",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "307-332-2223",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "WY",
            "license": "6275A",
            "primary": true
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Advanced Practice Midwife",
            "state": "WY",
            "license": "8746.0044",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lander, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.