1023047446 NPI number — JAMES C CHANEY A.R.N.P.

Table of content: JAMES C CHANEY A.R.N.P. (NPI 1023047446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023047446 NPI number — JAMES C CHANEY A.R.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANEY
Provider First Name:
JAMES
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
A.R.N.P.
Provider Gender Code:
M

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:
1023047446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 244
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GONZALEZ
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32560-0244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-623-2948
Provider Business Mailing Address Fax Number:
850-626-2734

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 SUGARBOWL LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-418-2128
Provider Business Practice Location Address Fax Number:
850-916-0788
Provider Enumeration Date:
06/30/2006

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: 363L00000X , with the licence number:  2210632 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 302818600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00297615 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 17449 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 591-69733 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com