1013194182 NPI number — MANUEL R CHAVARRI, MD, PLLC

Table of content: (NPI 1013194182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013194182 NPI number — MANUEL R CHAVARRI, MD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANUEL R CHAVARRI, MD, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013194182
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 S FIRST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALPENA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49707-2812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-354-8500
Provider Business Mailing Address Fax Number:
989-354-8200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 S FIRST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALPENA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49707-2812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-354-8500
Provider Business Practice Location Address Fax Number:
989-354-8200
Provider Enumeration Date:
01/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CHAVARRI
Authorized Official First Name:
MANUEL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
989-657-2925

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  MC034224 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0P56870 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1923054 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: MC034224 . This is a "STATE MEDICAL LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1100410341 . This is a "BCBSM INDIVIDUAL #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1033102132 . This is a "PERSONAL NPI FOR MANUEL R. CHAVARRI, MD, FACE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1100410711 . This is a "BCBSM NEW PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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