1821294984 NPI number — CHANEY, COUCH & ASSOCIATES

Table of content: (NPI 1821294984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821294984 NPI number — CHANEY, COUCH & ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHANEY, COUCH & ASSOCIATES
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:
D/B/A CHANEY COUCH & GROOTERS FAMILY DENTISTRY
Provider Other Organization Name Type Code:
4
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:
1821294984
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3612 AUSTIN DAVIS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32308-7401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-877-0215
Provider Business Mailing Address Fax Number:
850-329-2642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3612 AUSTIN DAVIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32308-7401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-877-0215
Provider Business Practice Location Address Fax Number:
850-329-2642
Provider Enumeration Date:
06/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOLLIFIELD
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
KAYE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
850-877-0215

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DN8129 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DN16145 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 60053 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 60053 . This is a "BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com