JACK MCINTYRE KIMMELL (NPI# 1740731116) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740731116 |
| Entity Type | Individual |
| Full Name | JACK MCINTYRE KIMMELL |
| Practice Address |
1526 East Lasalle South Bend IN 46617 |
| Mailing Address |
1526 E Lasalle Ave South Bend IN 46617-2606 |
| Practice Telephone | 5743101911 |
| Mailing Telephone | 5743101911 |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2016-10-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
3925375607 | IN | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | 3925375607 | IN | Student, Health Care |
| Street Address |
1526 EAST LASALLE |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46617 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023429115 | Morning View Assisted Living LLC | Assisted Living Facility | 475 N. Niles Avenue, South Bend, IN 46617 | 2014-05-12 |
| 1265861231 | Rebecca Busenbark | Physical Therapist | 401 E Colfax Ave Ste 102, South Bend, IN 46617 | 2013-11-11 |
| 1962709071 | Doreen Danice Huddleston | Social Worker | 928 East Wayne St, Suit C, South Bend, IN 46617 | 2011-02-25 |
| 1487981734 | Mary Cecilia Roemer | Marriage & Family Therapist | 616 E. Colfax Ave, South Bend, IN 46617 | 2009-11-06 |
| 1225264054 | Sridhar Meda | Dentist | 1005 East Lasalle Ave, South Bend, IN 46617 | 2009-06-08 |
| 1063673531 | Madeline Christina Watkins | Counselor | 616 E Colfax, South Bend, IN 46617 | 2008-06-18 |
| 1437366481 | Michael Reed Johns | Dentist | 103 South Eddy Street, South Bend, IN 46617 | 2007-05-17 |
| 1194937680 | Sarah Elizabeth Redman | Specialist/Technologist | 53880 Carmichael Dr., South Bend, IN 46617 | 2007-05-04 |
| 1124241211 | Trixy Franke | Family Medicine | 837 E. Cedar St., Ste 100, South Bend, IN 46617 | 2007-04-10 |
| 1366579005 | South Bend Childrens Dentistry PC | Dentist | 103 S Eddy, South Bend, IN 46617 | 2007-02-28 |
| Find all providers in zip 46617 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255967352 | John R Majewski | Student in an Organized Health Care Education/Training Program | 1402 Portage Ave, South Bend, IN 46616-1733 | 2020-03-20 |
| 1023632114 | Dayna Gumm | Student in an Organized Health Care Education/Training Program | 4526 W Western Ave, South Bend, IN 46619-2302 | 2020-06-03 |
| 1457972499 | Megan Susanne Spencer | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-30 |
| 1588284079 | Madeline Grace Chandler | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-24 |
| 1255951968 | Kallie Kram | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-22 |
| 1235759069 | Audrieanna Marie Kramer | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-22 |
| 1417577271 | Deborah Michelle Pavey | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-22 |
| 1841810702 | Kaitlin Vanderkolk | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-21 |
| 1982224879 | Allyson Nicole Dimagno | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-21 |
| 1609496686 | Garrett Muhlstadt | Student in an Organized Health Care Education/Training Program | 714 N Michigan St, South Bend, IN 46601-1035 | 2020-04-20 |
| Find all providers in SOUTH BEND | ||||
| City | SOUTH BEND |
| Zip Code | 46617 |
Please comment or provide details below to improve the information on JACK MCINTYRE KIMMELL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.