Provider Demographics
NPI:1306452305
Name:SIMS, JEAN MARC
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:MARC
Last Name:SIMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12203 CLIFTON BLVD APT 35
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-2169
Mailing Address - Country:US
Mailing Address - Phone:347-993-0490
Mailing Address - Fax:
Practice Address - Street 1:12203 CLIFTON BLVD APT 35
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-2169
Practice Address - Country:US
Practice Address - Phone:347-993-0490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator