1831185826 NPI number — C&K EXPRESS, LLC

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 1831185826 NPI number — C&K EXPRESS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C&K EXPRESS, LLC
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:
Provider Other Organization Name Type Code:
6
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:
1831185826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 357
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT SHASTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96067-0357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-918-9200
Provider Business Mailing Address Fax Number:
530-918-9100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 DAKOTA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUTHERLIN
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97479-9869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-459-5811
Provider Business Practice Location Address Fax Number:
541-459-5556
Provider Enumeration Date:
09/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RICHMOND
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT RPE, MEMBER
Authorized Official Telephone Number:
530-918-9200

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  001994 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 001994 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 001994 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 005894 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 182787 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 133506 . This is a "MEDICARE FLU" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3814717 . This is a "NCPDP" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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