Basic Information
| Provider Information | |||||||||
| NPI: | 1396910469 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAIN | ||||||||
| FirstName: | ARIHANT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 CROSS ST | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 646448312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165832151 | ||||||||
| FaxNumber: | 8165832342 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 CROSS ST | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 646448312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165832151 | ||||||||
| FaxNumber: | 8165832342 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2008 | ||||||||
| LastUpdateDate: | 08/19/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2010020746 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1396910469 | 05 | MO | MEDICAID |