Active NPI
Charles Daniel Egbert Jr., HS DIPLOMA, CAREGIVE
- Attendant Care Provider
- Arkdale, WI
National Provider Identifier
1861034613
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Attendant Care Provider
- Practice address
- 1105 County Road C
Arkdale, WI 54613 - Phone
- (608) 403-2440
- NPI assigned
- Oct 14, 2019
- Last updated
- Oct 14, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Attendant Care Provider | 3747A0650X | Primary |
Addresses
Primary practice location
1105 County Road C
Arkdale, WI 54613
Mailing address
450 E. State St. P.O. Box 1068
Adams, WI 53910
Phone (608) 339-7600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- High School Graduate
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571011200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571011200000",
"number": "1861034613",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 E. STATE ST. P.O. BOX 1068",
"city": "ADAMS",
"state": "WI",
"postal_code": "53910",
"telephone_number": "608-339-7600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1105 COUNTY ROAD C",
"city": "ARKDALE",
"state": "WI",
"postal_code": "54613",
"telephone_number": "608-403-2440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EGBERT",
"first_name": "CHARLES",
"middle_name": "DANIEL",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "HS DIPLOMA, CAREGIVE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-10-14",
"last_updated": "2019-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "3747A0650X",
"taxonomy_group": "",
"desc": "Technician, Attendant Care Provider",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arkdale, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.