1457333460 NPI number — DR. ROLANDO L CHENG M.D.

Table of content: DR. ROLANDO L CHENG M.D. (NPI 1457333460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457333460 NPI number — DR. ROLANDO L CHENG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHENG
Provider First Name:
ROLANDO
Provider Middle Name:
L
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:
1457333460
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2801 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POCAHONTAS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72455-9436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-892-6265
Provider Business Mailing Address Fax Number:
870-892-6271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 CAMP RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POCAHONTAS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72455-9131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-235-0960
Provider Business Practice Location Address Fax Number:
859-235-3690
Provider Enumeration Date:
11/16/2005

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: 207X00000X , with the licence number:  E6308 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 64213267 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90012188 . This is a "MEDICAID DME" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 14958526000 . This is a "OHIO BUREAU OF WORKERS CO" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0228330001 . This is a "MEDICARE DME" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611009038 . This is a "TAX ID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0228330001 . This is a "DMERC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1061251 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000047713 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 65901761 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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