1235245101 NPI number — STEPHEN J CHAPMAN DPM D/B/A FAMILY FOOT CENTER

Table of content: (NPI 1235245101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235245101 NPI number — STEPHEN J CHAPMAN DPM D/B/A FAMILY FOOT CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN J CHAPMAN DPM D/B/A FAMILY FOOT CENTER
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:
6
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:
1235245101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 WALNUT COMMONS LANE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
COOKEVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38501-6037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-528-1331
Provider Business Mailing Address Fax Number:
931-528-6893

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 WALNUT COMMONS LANE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
COOKEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-528-1331
Provider Business Practice Location Address Fax Number:
931-528-6893
Provider Enumeration Date:
08/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHAPMAN
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
PODIATRIST/OWNER
Authorized Official Telephone Number:
931-528-1331

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  DPM0000000352 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3351893 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CJ4133 . This is a "MEDICARE RAILROAD GROUP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 8069619 . This is a "CIGNA HEALTH CARE INS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 480014986 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0084212 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 368623135 . This is a "TRICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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