1437523305 NPI number — ALEXANDER JAMES CHALOUX PA-C

Table of content: ALEXANDER JAMES CHALOUX PA-C (NPI 1437523305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437523305 NPI number — ALEXANDER JAMES CHALOUX PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHALOUX
Provider First Name:
ALEXANDER
Provider Middle Name:
JAMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1437523305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
569 32 RD STE 12
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND JUNCTION
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81504-6095
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-523-3544
Provider Business Mailing Address Fax Number:
970-434-3422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
935 HIGHLAND BLVD STE 2200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOZEMAN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59715-6915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-414-5700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2015

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: 363A00000X , with the licence number:  43550 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA.0005116 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9000155890 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0005116 . This is a "STATE LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".