1275537839 NPI number — DR. PAUL L CHESIS MD

Table of content: DR. PAUL L CHESIS MD (NPI 1275537839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275537839 NPI number — DR. PAUL L CHESIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHESIS
Provider First Name:
PAUL
Provider Middle Name:
L
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:
1275537839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1675 E MAIN ST
Provider Second Line Business Mailing Address:
BOX 328
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44240-5818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-593-1049
Provider Business Mailing Address Fax Number:
330-572-3836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1675 E MAIN ST
Provider Second Line Business Practice Location Address:
BOX 328
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44240-5818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-593-1049
Provider Business Practice Location Address Fax Number:
330-572-3836
Provider Enumeration Date:
06/10/2005

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: 2085R0204X , with the licence number:  35.122933 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100285030C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00475725 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 100285030E , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23979028 . This is a "BCBS OF KC MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 100285030D , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0098946 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23979118 . This is a "BCBS KC GRP#18959016" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 203108634 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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