1144402793 NPI number — CHAUNCEY B SANTOS MD

Table of content: CHAUNCEY B SANTOS MD (NPI 1144402793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144402793 NPI number — CHAUNCEY B SANTOS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTOS
Provider First Name:
CHAUNCEY
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1144402793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 490
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHLANDS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24641-0490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-951-8241
Provider Business Mailing Address Fax Number:
276-596-6717

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6719 GOV G C PEERY HWY
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
RICHLANDS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24641-0880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-596-6715
Provider Business Practice Location Address Fax Number:
276-596-6717
Provider Enumeration Date:
12/05/2007

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: 207X00000X , with the licence number:  30089 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 89135PY , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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