1194990622 NPI number — DR. JOEL P CHISHOLM MD

Table of content: DR. JOEL P CHISHOLM MD (NPI 1194990622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194990622 NPI number — DR. JOEL P CHISHOLM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHISHOLM
Provider First Name:
JOEL
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1194990622
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 HOSPITAL RD
Provider Second Line Business Mailing Address:
CALLER BOX C-268
Provider Business Mailing Address City Name:
CHEROKEE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28719-9253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-497-9163
Provider Business Mailing Address Fax Number:
828-497-1723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
375 SEQUOYAH TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEROKEE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-497-6892
Provider Business Practice Location Address Fax Number:
828-497-1723
Provider Enumeration Date:
04/25/2008

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: 2084P0800X , with the licence number:  MD47420 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0802X , with the licence number: 200901554 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1194990622 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 19AKY . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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