1427051135 NPI number — TAMARA S CHANCE D.O.

Table of content: TAMARA S CHANCE D.O. (NPI 1427051135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427051135 NPI number — TAMARA S CHANCE D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANCE
Provider First Name:
TAMARA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

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:
1427051135
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 UNION ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOONE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50036-4821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-433-8498
Provider Business Mailing Address Fax Number:
515-433-8965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 W WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OGDEN
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50212-3060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-275-2417
Provider Business Practice Location Address Fax Number:
515-275-4678
Provider Enumeration Date:
05/27/2005

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: 207Q00000X , with the licence number:  DO-03013 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: 03013 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 31622 . This is a "BCBS PROVIDER #" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 2165605 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 546840012 . This is a "MEDICARE PTAN" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 546830011 . This is a "MEDICARE PTAN" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".