1538154828 NPI number — STANLEY J KUPCHINSKY CRNA

Table of content: STANLEY J KUPCHINSKY CRNA (NPI 1538154828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538154828 NPI number — STANLEY J KUPCHINSKY CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUPCHINSKY
Provider First Name:
STANLEY
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1538154828
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSPORT
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37662-1308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-224-3460
Provider Business Mailing Address Fax Number:
423-224-3465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 W RAVINE RD
Provider Second Line Business Practice Location Address:
SUITE 5 B
Provider Business Practice Location Address City Name:
KINGSPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37660-3847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-224-3460
Provider Business Practice Location Address Fax Number:
423-224-3465
Provider Enumeration Date:
09/13/2005

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: 367500000X , with the licence number:  9502 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 261969 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9556184 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: TN0100 . This is a "JOHN DEERE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 74216938 . This is a "KY MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3046126 . This is a "BLUE SHIELD OF TN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00013859 . This is a "NHC CARE ADMINISTRATORS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3605194 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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