1659547347 NPI number — CASSANDRA CHAPMON PAINTER BCABA

Table of content: CASSANDRA CHAPMON PAINTER BCABA (NPI 1659547347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659547347 NPI number — CASSANDRA CHAPMON PAINTER BCABA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAINTER
Provider First Name:
CASSANDRA
Provider Middle Name:
CHAPMON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BCABA
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:
1659547347
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 51322
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWLING GREEN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42102-5622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-777-9283
Provider Business Mailing Address Fax Number:
270-777-9283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2560 HARDEE COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29150-3214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-905-5107
Provider Business Practice Location Address Fax Number:
803-905-4431
Provider Enumeration Date:
05/02/2008

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: 103K00000X , with the licence number:  0-04-1435 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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