1841247012 NPI number — DR. CHRISTINE J AMIS IV M.D.

Table of content: DR. CHRISTINE J AMIS IV M.D. (NPI 1841247012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841247012 NPI number — DR. CHRISTINE J AMIS IV M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMIS
Provider First Name:
CHRISTINE
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
IV
Provider Credential Text:
M.D.
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:
1841247012
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
923 ROUTE 6A
Provider Second Line Business Mailing Address:
SUNFLOWER MKT PLC UNIT N
Provider Business Mailing Address City Name:
YARMOUTH PORT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02675-2159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-360-5195
Provider Business Mailing Address Fax Number:
508-544-4266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
923 ROUTE 6A
Provider Second Line Business Practice Location Address:
SUNFLOWER MKT PLC UNIT N
Provider Business Practice Location Address City Name:
YARMOUTH PORT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02675-2159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-360-5195
Provider Business Practice Location Address Fax Number:
508-544-4266
Provider Enumeration Date:
05/31/2006

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: 2084P0800X , with the licence number:  219518 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2023558 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 004108074 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110078110A . This is a "MMIS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 219518 . This is a "MD LICENSE IN MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 013545330A . This is a "PTAN ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2147092 . This is a "MASS HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J29522 . This is a "BC/BS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 494241 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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