1184738882 NPI number — CHRISTOPHER BRYS DAVIS MSN LICSW

Table of content: CHRISTOPHER BRYS DAVIS MSN LICSW (NPI 1184738882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184738882 NPI number — CHRISTOPHER BRYS DAVIS MSN LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
CHRISTOPHER
Provider Middle Name:
BRYS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN LICSW
Provider Gender Code:
M

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:
1184738882
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 20TH ST S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ULM
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56073-2223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-766-7685
Provider Business Mailing Address Fax Number:
507-216-6600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 20TH ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ULM
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56073-2223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-766-7685
Provider Business Practice Location Address Fax Number:
507-216-6600
Provider Enumeration Date:
08/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  17460 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 943071045367 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6238565 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 802944000 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 289P6DA . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: I15582 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".