MEDICARE: DR. JACQUELINE K GIVIDEN M.D.

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
1	207L00000X	Anesthesiology Physician	01060188A	IN
2	207L00000X	Anesthesiology Physician	2020-04712	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	P00265884	OTHER	IN	RAILROAD MEDICARE
18	134960H	OTHER	IN	UNICARE MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200512950	OTHER	IN	MDWISE HOOSIER ALLIANCE
2	2684317000	OTHER	IN	PASSPORT ADVANTAGE
3	000000361232	OTHER	KY	ANTHEM
4	000000361232	OTHER	IN	UNICARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	000000361232	OTHER	IN	INDIANA COMPREHENSIVE
7	000000361232	OTHER	IN	ANTHEM
8	200512950	OTHER	IN	MANAGED HEALTH SERVICES
10	000000361232	OTHER	IN	HEALTHLINK
11	000000361232	OTHER	IN	ANTHEM SENIOR ADVANTAGE
12	000000361232	OTHER	IN	ONE NATION BENEFIT
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	50009617	OTHER		PASSPORT
16	129703800	OTHER	IN	BLACK LUNG PROGRAM
17	129703800	OTHER	IN	US DEPT OF LABOR

General Provider Information

NPI Number	:	1699740076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE K GIVIDEN M.D.

Provider Business Mailing Address
First Line	:	2080 W ARLINGTON BLVD STE B
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-3770
Country	:	US
Telephone Number	:	252-752-2140
Fax Number	:	252-689-6502

Provider Business Practice Location Address
First Line	:	2080 W ARLINGTON BLVD STE B
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-3770
Country	:	US
Telephone Number	:	252-752-2140
Fax Number	:	252-689-6502

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	01/06/2021

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