1811998461 NPI number — CHESAPEAKE INFUSION INC.

Table of content: (NPI 1811998461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811998461 NPI number — CHESAPEAKE INFUSION INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESAPEAKE INFUSION 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:
1811998461
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6272 LEE VISTA BLVD
Provider Second Line Business Mailing Address:
LEGAL DEPT.
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32822-5148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-773-7376
Provider Business Mailing Address Fax Number:
888-773-7386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 QUIGLEY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19720-4104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-540-4755
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSTON
Authorized Official First Name:
GAYLE
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF OPERATIONS
Authorized Official Telephone Number:
407-854-6532

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  A3-0000703 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 330689 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54003413 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1914645 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0015431 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000014390 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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