1093027591 NPI number — CHRIS FRANKLIN DO PC

Table of content: (NPI 1093027591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093027591 NPI number — CHRIS FRANKLIN DO PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRIS FRANKLIN DO PC
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:
LAKE AREA CLINIC
Provider Other Organization Name Type Code:
5
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:
1093027591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
948 EAST US HWY 54
Provider Second Line Business Mailing Address:
P.O. BOX 1380
Provider Business Mailing Address City Name:
CAMDENTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65020-1380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-346-4446
Provider Business Mailing Address Fax Number:
573-346-2975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
948 EAST US HIGHWAY 54
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDENTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65020-6834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-346-4446
Provider Business Practice Location Address Fax Number:
573-346-2975
Provider Enumeration Date:
07/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FRANKLIN
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
CHRIS
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
573-346-4446

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000094814 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 241797224 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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