1588900427 NPI number — MARTA G CHANEY LLC

Table of content: (NPI 1588900427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588900427 NPI number — MARTA G CHANEY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTA G CHANEY LLC
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:
1588900427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5501 SUFFIELD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21044-2772
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3691 PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLICOTT CITY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21043-4783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-707-5893
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CHANEY
Authorized Official First Name:
MARTA
Authorized Official Middle Name:
GAY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-707-5893

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  05213 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: K452 . This is a "BSDC" identifier . This identifiers is of the category "OTHER".
  • Identifier: PVPB117117 . This is a "APS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 150N . This is a "MBMD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 150N119G . This is a "MEDICARE UNSPECIFIED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0003 . This is a "BSDC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 150N119G . This is a "MBMD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 253537 . This is a "COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 226574 . This is a "KAIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 331942 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 360218 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54264604 . This is a "BSMD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 252450 . This is a "COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 705BPS . This is a "BSMD" identifier . This identifiers is of the category "OTHER".




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