1437153855 NPI number — CASANDRA L CANSLER M.D.

Table of content: CASANDRA L CANSLER M.D. (NPI 1437153855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437153855 NPI number — CASANDRA L CANSLER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANSLER
Provider First Name:
CASANDRA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1437153855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIXSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37343-0301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-332-8633
Provider Business Mailing Address Fax Number:
423-332-8634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8804 DAYTON PIKE
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
SODDY DAISY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37379-4306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-332-8633
Provider Business Practice Location Address Fax Number:
423-332-8634
Provider Enumeration Date:
06/13/2005

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: 207R00000X , with the licence number:  28697 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 28697 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3150573 . This is a "BLUECROSS BLUESHIELD TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3819039 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".