1205203056 NPI number — GEETHA CHANDRASHEKAR M.D.

Table of content: GEETHA CHANDRASHEKAR M.D. (NPI 1205203056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205203056 NPI number — GEETHA CHANDRASHEKAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANDRASHEKAR
Provider First Name:
GEETHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1205203056
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 E BRADFORD PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65804-4264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-761-5000
Provider Business Mailing Address Fax Number:
417-761-5011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 N WILLIAMS ST UNIT C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBERLY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65270-1583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-263-7651
Provider Business Practice Location Address Fax Number:
660-263-2815
Provider Enumeration Date:
08/27/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  2019009736 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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