Provider Demographics
NPI:1821294984
Name:CHANEY, COUCH & ASSOCIATES
Entity Type:Organization
Organization Name:CHANEY, COUCH & ASSOCIATES
Other - Org Name:D/B/A CHANEY COUCH & GROOTERS FAMILY DENTISTRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:HOLLIFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-877-0215
Mailing Address - Street 1:3612 AUSTIN DAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-7401
Mailing Address - Country:US
Mailing Address - Phone:850-877-0215
Mailing Address - Fax:850-329-2642
Practice Address - Street 1:3612 AUSTIN DAVIS AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-7401
Practice Address - Country:US
Practice Address - Phone:850-877-0215
Practice Address - Fax:850-329-2642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN8129122300000X, 122300000X
FLDN16145122300000X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL60053OtherBLUE CROSS BLUE SHIELD
FL60053OtherBC/BS