Provider Demographics
NPI:1144676552
Name:PRICE, JASON (M A)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:PRICE
Suffix:
Gender:M
Credentials:M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SUMMER GLENN PL
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0430
Mailing Address - Country:US
Mailing Address - Phone:903-293-2975
Mailing Address - Fax:
Practice Address - Street 1:1322 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-2016
Practice Address - Country:US
Practice Address - Phone:580-298-9958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator