1215078977 NPI number — REGIONAL OBSTETRIC CONSULTANTS

Table of content: CHEYENNE LYNN FRALICK DC (NPI 1558590141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215078977 NPI number — REGIONAL OBSTETRIC CONSULTANTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGIONAL OBSTETRIC CONSULTANTS
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:
1215078977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
836 PRUDENTIAL DR
Provider Second Line Business Mailing Address:
SUITE 1800
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32207-8334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-398-7684
Provider Business Mailing Address Fax Number:
904-398-4998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
836 PRUDENTIAL DR
Provider Second Line Business Practice Location Address:
SUITE 1800
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32207-8334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-398-7684
Provider Business Practice Location Address Fax Number:
904-398-4998
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THRASHER
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
KAYE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
904-398-7684

Provider Taxonomy Codes

  • Taxonomy code: 207VM0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 77611 . This is a "BLUE CROSS BLUE SHHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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