1902880222 NPI number — CHERYL ROSE PARKS CRNA

Table of content: CHERYL ROSE PARKS CRNA (NPI 1902880222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902880222 NPI number — CHERYL ROSE PARKS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKS
Provider First Name:
CHERYL
Provider Middle Name:
ROSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1902880222
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 790058
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63179-0058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-549-2380
Provider Business Mailing Address Fax Number:
314-569-5974

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 THOMAS JOHNSON DR
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702-4425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-694-3400
Provider Business Practice Location Address Fax Number:
301-694-3620
Provider Enumeration Date:
11/30/2005

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: 364S00000X , with the licence number:  RO68640 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00137653 . This is a "MEDICARE RAILROAD (PTAN CJ8689)" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P00687678 . This is a "MEDICARE RAILROAD (PTAN DD6120)" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: S417-0007 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: KBC1CH . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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