Provider Demographics
NPI:1639348063
Name:CHEAIRS, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:CHEAIRS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 1ST ST
Mailing Address - Street 2:STE 784
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6533
Mailing Address - Country:US
Mailing Address - Phone:505-434-1314
Mailing Address - Fax:505-434-1631
Practice Address - Street 1:700 1ST ST
Practice Address - Street 2:STE 784
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6533
Practice Address - Country:US
Practice Address - Phone:505-434-1314
Practice Address - Fax:505-434-1631
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03035967008332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM5419160001Medicare NSC