Jacob Samuel Modesitt
Student in an Organized Health Care Education/Training Program in Dallas, TX. Individual provider (NPI-1).
Details
- NPI
- 1023719986
- Entity type
- Individual (NPI-1)
- Name
- Jacob Samuel Modesitt
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 16, 2023
- Certification date
- Apr 21, 2024
- Last updated
- Apr 21, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
Practice location
3500 Gaston AveDallas, TX 75246-2017
Phone 559-308-9231
Mailing address
2217 4th Ave NGreat Falls, MT 59401-2803
Phone 559-308-9231
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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