1427120187 NPI number — SUNIL G & NILIMA P CHAND

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427120187 NPI number — SUNIL G & NILIMA P CHAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNIL G & NILIMA P CHAND
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHANDS MEDICAL OFFICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427120187
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63640-0107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-756-7880
Provider Business Mailing Address Fax Number:
573-756-2669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1031 E KARSCH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63640-3404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-756-7880
Provider Business Practice Location Address Fax Number:
573-756-2669
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHAND
Authorized Official First Name:
SUNIL
Authorized Official Middle Name:
GUPTA
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
573-756-7880

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  109268 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CI1852 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 505183608 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590121307 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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