Provider Demographics
NPI:1336321405
Name:CHAUVOT, REGIS JOEL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:REGIS
Middle Name:JOEL
Last Name:CHAUVOT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-0550
Mailing Address - Country:US
Mailing Address - Phone:803-435-8463
Mailing Address - Fax:803-435-3196
Practice Address - Street 1:10 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-0550
Practice Address - Country:US
Practice Address - Phone:803-435-8463
Practice Address - Fax:803-435-3196
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCRNA37309367500000X
SCAPRN372367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20045748OtherSELECT HEALTH
SCAN0582Medicaid
P00322348OtherRR MEDICARE
SC000000178206OtherUNISON
SCAN0582Medicaid