1700970209 NPI number — CHAS ENTERPRISES

Table of content: (NPI 1700970209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700970209 NPI number — CHAS ENTERPRISES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHAS ENTERPRISES
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:
1700970209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4614 WEST MARKET ST.
Provider Second Line Business Mailing Address:
#B
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27407-1400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-547-8117
Provider Business Mailing Address Fax Number:
336-855-6155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4614 WEST MARKET ST.
Provider Second Line Business Practice Location Address:
#B
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27407-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-547-8117
Provider Business Practice Location Address Fax Number:
336-855-6155
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHLOSSBERG
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
336-547-8117

Provider Taxonomy Codes

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

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

  • Identifier: 37468 . This is a "PARTNERS INS." identifier . This identifiers is of the category "OTHER".
  • Identifier: 90002007 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08601804 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9108246 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 045H9 . This is a "BC BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: CE55253 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 888368A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7702912 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: DE2194 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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