1003873365 NPI number — MRS. CARRIE DENISE CLINE III MA CCCA

Table of content: MRS. CARRIE DENISE CLINE III MA CCCA (NPI 1003873365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003873365 NPI number — MRS. CARRIE DENISE CLINE III MA CCCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLINE
Provider First Name:
CARRIE
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
III
Provider Credential Text:
MA CCCA
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:
1003873365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
352 HUNTINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14214-1542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
416-874-4500
Provider Business Mailing Address Fax Number:
716-874-8145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2128 ELMWOOD AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14207-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
416-874-4500
Provider Business Practice Location Address Fax Number:
716-874-8145
Provider Enumeration Date:
04/28/2006

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: 231H00000X , with the licence number:  0018381 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01465154 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00026873201 . This is a "UNIVERA COMMERCIAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00026873201 . This is a "PLUSMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000576115007 . This is a "COMMUNITY BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000576115007 . This is a "CB ADVANTAGE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000576115007 . This is a "CB LABOR HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000576115007 . This is a "COMMUNITY CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000576115007 . This is a "BCBS WNY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00026873201 . This is a "UNIVERA MEDICARE PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00026873201 . This is a "CHILDHEALTH PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000576115007 . This is a "CHILD HEALTH PLUS FAMILY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00026873201 . This is a "ASO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000576115007 . This is a "HMO 100" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00026873201 . This is a "UNIVERA HEALTHCARE TRADI" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00187911 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000576115007 . This is a "HEALTHY NY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000576115007 . This is a "SENIOR BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000576115007 . This is a "TRADITIONAL" identifier . This identifiers is of the category "OTHER".




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