1659372092 NPI number — MR. CHAD A TRUMAN PA-C

Table of content: MR. CHAD A TRUMAN PA-C (NPI 1659372092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659372092 NPI number — MR. CHAD A TRUMAN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRUMAN
Provider First Name:
CHAD
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
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:
1659372092
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 GOVERNORS DR SW FL 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35801-5171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-801-6049
Provider Business Mailing Address Fax Number:
256-539-0856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 GOVERNORS DR SW FL 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-5171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-533-1600
Provider Business Practice Location Address Fax Number:
256-539-0856
Provider Enumeration Date:
08/09/2005

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: 363A00000X , with the licence number:  PA9105021 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: PA9105021 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: PA.352 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 002349600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01024462 . This is a "MEDICARE RAILROAD PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".