1962493619 NPI number — ERIC SCOTT CHENVEN M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962493619 NPI number — ERIC SCOTT CHENVEN M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CHENVEN

Provider First Name:

ERIC

Provider Middle Name:

SCOTT

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1962493619

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/28/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2234 COLONIAL BLVD

Provider Second Line Business Mailing Address:

MANAGED CARE DEPT.

Provider Business Mailing Address City Name:

FORT MYERS

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

33907-1412

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

239-931-7342

Provider Business Mailing Address Fax Number:

239-931-7385

Provider First Line Business Practice Location Address:

1200 E BROWARD BLVD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

FORT LAUDERDALE

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

33301-2134

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

954-463-6408

Provider Business Practice Location Address Fax Number:

954-463-1858

Provider Enumeration Date:

11/02/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208800000X , with the licence number:  ME87659 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1192963 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 79056 . This is a "BLUECROSS BLUESHIELD OF FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 000056842Z . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P0003137 . This is a "FLORIDA HEALTHCARE PLUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 6902213 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P00731868 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 2677903-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 11985 . This is a "MEDICA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: PRL00000274253 . This is a "PREFERRED MEDICAL PLAN (COMM/MEDICARE)" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 10201 . This is a "DIMENSION HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 267790300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".