1275577249 NPI number — DR. ALEXANDER N CHUNG M.D.

Table of content: DR. ALEXANDER N CHUNG M.D. (NPI 1275577249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275577249 NPI number — DR. ALEXANDER N CHUNG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHUNG
Provider First Name:
ALEXANDER
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1275577249
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 25TH ST S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREAT FALLS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59405-5183
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-731-8888
Provider Business Mailing Address Fax Number:
406-731-8876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 15TH AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREAT FALLS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59405-4324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-731-8888
Provider Business Practice Location Address Fax Number:
406-731-8318
Provider Enumeration Date:
06/16/2006

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: 207X00000X , with the licence number:  9576 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0106X , with the licence number: 9576 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0148236 . This is a "WASHINGTON L & I" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 184609700 . This is a "FEDERAL WORK COMP" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 200039889 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 000092241 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0027833 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 810347861011 . This is a "EBMS" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 810347861 . This is a "CHAMPUS" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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