=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568348225
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHM MOBILE CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2025
-----------------------------------------------------
Last Update Date | 11/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3499 BLAZER PKWY STE 330
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40509-2828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-877-6601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6802 PARAGON PL STE 410
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23230-1655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-435-8085
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING & CREDENTIALING MANAGER
-----------------------------------------------------
Name | ANGEL M RIVERA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-435-8085
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------