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NPI Code Detail

MEDICARE: JETTA L ALMON CST, CSFA

MEDICARE: JETTA L ALMON CST, CSFA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1246ZC0007XSurgical Assistant95829IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000001069797OTHERINANTHEM BCBS

General Provider Information

NPI Number : 1104073519
Entity Type Code : Individual
Provider Name (Legal Business Name) : JETTA L ALMON CST, CSFA
Provider Business Mailing Address
First Line : 1207 SE RIVERSIDE DR
Second Line :
City : EVANSVILLE
State : IN
Zip : 47713-1166
Country : US
Telephone Number : 812-484-2689
Fax Number :
Provider Business Practice Location Address
First Line : 1207 SE RIVERSIDE DR
Second Line :
City : EVANSVILLE
State : IN
Zip : 47713-1166
Country : US
Telephone Number : 812-484-2689
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2008
Last Update Date : 05/03/2019

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Directions to “ JETTA L ALMON CST, CSFA” Practice Location

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