1609870047 NPI number — APAMA K CHILDERS P.A.

Table of content: APAMA K CHILDERS P.A. (NPI 1609870047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609870047 NPI number — APAMA K CHILDERS P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHILDERS
Provider First Name:
APAMA
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
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:
1609870047
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 N HERITAGE DR STE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIDGECREST
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93555-5537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-446-4571
Provider Business Mailing Address Fax Number:
760-446-0970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 N HERITAGE DR STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGECREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93555-5537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-446-8281
Provider Business Practice Location Address Fax Number:
760-446-0970
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: 363AM0700X , with the licence number:  PA10602 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00G570660 . This is a "COMMERCIAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010032908 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 154460165 . This is a "PALMETTO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0616650001 . This is a "DME" identifier . This identifiers is of the category "OTHER".
  • Identifier: 688278 . This is a "AHI HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0PA106020 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00G570660 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00G570660 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: G57066 . This is a "IMG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 93555B033 . This is a "WPS TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: CA0103 . This is a "JOHN DEERE" identifier . This identifiers is of the category "OTHER".