MEDICARE: MR. GEORGE M WINE CHASE M.DIV., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2669	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27215019	OTHER	MO	BCBS PROVIDER #
2	WINE CHASE	OTHER	MO	COVENTRY/MHNET
3	48-1180532	OTHER	MO	UBH PROVIDER #
4	48118053264111B004	OTHER		TRICARE
5	WINE CHASE	OTHER	MO	HUMANA/CHOICECARE/CORPHEALTH/LIFESYNCH
6	WINE CHASE	OTHER	MO	MULTIPLAN/PHCS
7	569447	OTHER	MO	VALUEOPTIONS
8	7968347	OTHER	MO	AETNA
9	2322864	OTHER	MO	CIGNA

General Provider Information

NPI Number	:	1598732273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE M WINE CHASE M.DIV., M.S.

Provider Business Mailing Address
First Line	:	9233 WARD PKWY
Second Line	:	SUITE 305
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-3366
Country	:	US
Telephone Number	:	816-824-9898
Fax Number	:	816-527-8052

Provider Business Practice Location Address
First Line	:	9233 WARD PKWY
Second Line	:	SUITE 305
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-3366
Country	:	US
Telephone Number	:	816-824-9898
Fax Number	:	816-527-8052

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	11/02/2010

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