1679670897 NPI number — MIL. CHRIS, INC

Table of content: (NPI 1679670897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679670897 NPI number — MIL. CHRIS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIL. CHRIS, INC
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:
1679670897
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23988 US HIGHWAY 19 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33765-1563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-399-8040
Provider Business Mailing Address Fax Number:
727-214-9315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23988 US HIGHWAY 19 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33765-1563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-399-8040
Provider Business Practice Location Address Fax Number:
727-214-9315
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHEELER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
727-399-8040

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  AS1838 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 085120500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590200000 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: J0056 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: J0056 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 159762500 . This is a "WORKER'S COMPENSATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7102000 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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