Basic Information
| Provider Information | |||||||||
| NPI: | 1538104419 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHAPEL HILL INTERNAL MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 940 MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275142601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199425123 | ||||||||
| FaxNumber: | 9199425730 | ||||||||
| Practice Location | |||||||||
| Address1: | 940 MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275142601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199425123 | ||||||||
| FaxNumber: | 9199425730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 06/24/2010 | ||||||||
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| AuthorizedOfficialLastName: | CHAMBERLIN | ||||||||
| AuthorizedOfficialFirstName: | JEANNE | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9199510444 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RG0100X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RR0500X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01263 | 01 | NC | BLUE CROSS/BLUE SHIELD | OTHER |