1215396726 NPI number — MATT CHANAY

Table of content: MATT CHANAY (NPI 1215396726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215396726 NPI number — MATT CHANAY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANAY
Provider First Name:
MATT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1215396726
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 SHUMAN BLVD
Provider Second Line Business Mailing Address:
STE 401
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60563-8458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-303-5380
Provider Business Mailing Address Fax Number:
978-313-6824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
153 W 151ST ST
Provider Second Line Business Practice Location Address:
STE 140
Provider Business Practice Location Address City Name:
OLATHE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66061-5300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-883-2666
Provider Business Practice Location Address Fax Number:
913-764-6455
Provider Enumeration Date:
02/12/2016

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: 237700000X , with the licence number:  1628 , registered in the state of KS ; 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