1396879185 NPI number — CHRISTOPHER MD & ASSOCIATES, PA

Table of content: (NPI 1396879185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396879185 NPI number — CHRISTOPHER MD & ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTOPHER MD & ASSOCIATES, PA
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:
1396879185
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 E REDSTONE AVE
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
CRESTVIEW
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32539-5326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-682-6320
Provider Business Mailing Address Fax Number:
850-682-6339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 E REDSTONE AVE
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
CRESTVIEW
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32539-5326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-682-6320
Provider Business Practice Location Address Fax Number:
850-682-6339
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHRISTOPHER
Authorized Official First Name:
INDUMATHI
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
850-682-6320

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2012340 . This is a "FIRST HEALTH NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 274400700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1431330005 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7689404 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2236414005 . This is a "UNITED HEALTHCARE NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 31703 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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