1700397940 NPI number — CHEAHA AREA REGIONAL EMERGENCY SPECIALIST

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700397940 NPI number — CHEAHA AREA REGIONAL EMERGENCY SPECIALIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHEAHA AREA REGIONAL EMERGENCY SPECIALIST
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
C.A.R.E.S.
Provider Other Organization Name Type Code:
3
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:
1700397940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1325 QUINTARD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNISTON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-741-1339
Provider Business Mailing Address Fax Number:
256-741-1356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1219 ALMON ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
HEFLIN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-963-9441
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2017

Additional Information

Authorized Official

Authorized Official Last Name:
SNEAD
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
V
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
256-741-1339

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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