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JERRY FENWICK MD NPI 1366477549


NPI Information

NPI: 1366477549
Provider Name: JERRY FENWICK, MD
Classification: Emergency Medicine - 207P00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
771 N SUMMERCREEK CT
SPRINGFIELD, MO
ZIP 65802
Phone: (417) 771-4548
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Jerry Fenwick, MD is an emergency medicine in Springfield, MO. The provider is an emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. Jerry Fenwick, MD NPI is 1366477549. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

771 N SUMMERCREEK CT
SPRINGFIELD, MO
ZIP 65802-249
Phone: (417) 771-4548

The NPI 1366477549 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/12/2006 and was last updated on 1/20/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207P00000XEmergency Medicine110179MISSOURIYes
2207P00000XEmergency Medicine18407SOUTH CAROLINANo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11366477549MEDICAIDMISSOURI
2G38753MEDICAIDSOUTH CAROLINA
3208524116MEDICAIDMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.