1194422253 NPI number — CH SPECIALTY SERVICES MO LLC

Table of content: (NPI 1194422253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194422253 NPI number — CH SPECIALTY SERVICES MO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CH SPECIALTY SERVICES MO 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:
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:
1194422253
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5750 JOHNSTON ST STE 205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70503-5334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-408-0797
Provider Business Mailing Address Fax Number:
337-943-0846

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 SW LONGVIEW BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEES SUMMIT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64081-2116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-408-0797
Provider Business Practice Location Address Fax Number:
337-943-0846
Provider Enumeration Date:
02/09/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOWARD
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
SR VP OF ADMINISTRATIVE SERVICES
Authorized Official Telephone Number:
337-408-0797

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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