1043702061 NPI number — MR. LARRY D CHRISTY CACI-IN PROCESS

Table of content: MR. LARRY D CHRISTY CACI-IN PROCESS (NPI 1043702061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043702061 NPI number — MR. LARRY D CHRISTY CACI-IN PROCESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISTY
Provider First Name:
LARRY
Provider Middle Name:
D
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CACI-IN PROCESS
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:
1043702061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1644 JACKSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARNWELL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29812-2156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-541-1245
Provider Business Mailing Address Fax Number:
803-541-1247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1644 JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARNWELL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29812-2156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-541-1245
Provider Business Practice Location Address Fax Number:
803-541-1247
Provider Enumeration Date:
06/05/2018

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com