Provider Demographics
NPI:1750410296
Name:CHARICEM VENTURES PLLC
Entity type:Organization
Organization Name:CHARICEM VENTURES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AYODELE
Authorized Official - Middle Name:ADELEKE
Authorized Official - Last Name:OLUSANYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-855-3719
Mailing Address - Street 1:120 DAVY CROCKETT MALL
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382-2934
Mailing Address - Country:US
Mailing Address - Phone:731-855-3719
Mailing Address - Fax:731-855-1746
Practice Address - Street 1:120 DAVY CROCKETT MALL
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382-2934
Practice Address - Country:US
Practice Address - Phone:731-855-3719
Practice Address - Fax:731-855-1746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3735738Medicaid
TNDF6302OtherRAILROAD MEDICARE
TNH95679Medicare UPIN
TN3735738Medicaid