1285686766 NPI number — CHARLES W BROWN M.D.

Table of content: CHARLES W BROWN M.D. (NPI 1285686766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285686766 NPI number — CHARLES W BROWN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
CHARLES
Provider Middle Name:
W
Provider Name Prefix Text:
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:
1285686766
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6247
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SNOWMASS VILLAGE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81615-6247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-816-4549
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1326 EISENHOWER DR BLDG 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31406-3928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-691-4200
Provider Business Practice Location Address Fax Number:
912-303-3506
Provider Enumeration Date:
05/16/2006

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: 2085R0202X , with the licence number:  19165 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 48081 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 028509 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10025709000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52237053005 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: CO305926 . This is a "MEDICARE RIA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 200627500A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 85588555 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1285686766 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84059792913 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1285686766 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: N355708 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: P00347630 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000321087G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 474618 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47706252 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84089712600 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: CO305925 . This is a "MEDICARE MIC" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: P00760022 . This is a "RR MCR MIC" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 016476200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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