1508029661 NPI number — SCOTT A CHERNE, MD PA

Table of content: (NPI 1508029661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508029661 NPI number — SCOTT A CHERNE, MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOTT A CHERNE, MD 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:
1508029661
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10888
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97440-2888
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-687-9007
Provider Business Mailing Address Fax Number:
541-687-9120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1314 NW JOHN JONES DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLESON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76028-8040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-687-9007
Provider Business Practice Location Address Fax Number:
541-687-9120
Provider Enumeration Date:
07/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CHERNE
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
541-687-9007

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: M6081 . This is a "TEXAS MEDICAL LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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