Provider Demographics
NPI:1679670897
Name:MIL. CHRIS, INC
Entity type:Organization
Organization Name:MIL. CHRIS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:727-399-8040
Mailing Address - Street 1:23988 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1563
Mailing Address - Country:US
Mailing Address - Phone:727-399-8040
Mailing Address - Fax:727-214-9315
Practice Address - Street 1:23988 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1563
Practice Address - Country:US
Practice Address - Phone:727-399-8040
Practice Address - Fax:727-214-9315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS1838332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL085120500Medicaid
FL590200000OtherBLUE CROSS BLUE SHIELD
FLJ0056OtherBLUE CROSS BLUE SHIELD
MIJ0056OtherBLUE CROSS BLUE SHIELD
FL159762500OtherWORKER'S COMPENSATION
MI7102000OtherBLUE CROSS BLUE SHIELD