1881017580 NPI number — MS. CHELSEA LAUREN RESS PA-C

Table of content: MS. CHELSEA LAUREN RESS PA-C (NPI 1881017580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881017580 NPI number — MS. CHELSEA LAUREN RESS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RESS
Provider First Name:
CHELSEA
Provider Middle Name:
LAUREN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

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:
1881017580
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2331 FRANKLIN RD SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24014-1111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-544-3770
Provider Business Mailing Address Fax Number:
540-857-5306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2331 FRANKLIN RD SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24014-1111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-544-3770
Provider Business Practice Location Address Fax Number:
540-857-5306
Provider Enumeration Date:
01/31/2014

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:  0110004501 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: 0110004501 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1881017580 . This is a "TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1881017580 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1881017580 . This is a "MAGELLAN CCP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1881017580 . This is a "ANTHEM MEDIGAP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1881017580 . This is a "OPTIMA HEALTH PLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1881017580 . This is a "CCCP VIRGINIA PREMIER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1881017580 . This is a "COVENTRY/AETNA BETTER HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1881017580 . This is a "MEDICAID QMB" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1881017580 . This is a "IN TOTAL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1881017580 . This is a "UMWA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1881017580 . This is a "HUMANA MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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