Provider Demographics
NPI:1003926353
Name:BATES, CHAD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:
Last Name:BATES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:HMG CREDENTIALING
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2033 MEADOWVIEW LANE
Practice Address - Street 2:SUITE 200 HOLSTON MEDICAL GROUP PC
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660
Practice Address - Country:US
Practice Address - Phone:423-857-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241364207Q00000X
TN43411207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3001348Medicaid
VA1003926353Medicaid
VA015930W08Medicare PIN
TN103I086169Medicare UPIN
SCI26700Medicare UPIN
VA1003926353Medicaid
VAP00460043Medicare PIN
TN3700592Medicare UPIN