1457518227 NPI number — C. ANN MASHCHAK, M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457518227 NPI number — C. ANN MASHCHAK, M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C. ANN MASHCHAK, M.D.
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:
6
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:
1457518227
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 848873
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02284-8873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-624-9830
Provider Business Mailing Address Fax Number:
423-624-0773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9413 APISON PIKE
Provider Second Line Business Practice Location Address:
SUITE 124
Provider Business Practice Location Address City Name:
OOLTEWAH
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37363-8661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-624-9830
Provider Business Practice Location Address Fax Number:
423-624-0773
Provider Enumeration Date:
05/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MASHCHAK
Authorized Official First Name:
CLARISSA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER/OPERATOR
Authorized Official Telephone Number:
423-624-9830

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2004710 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3032077 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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