Provider Demographics
NPI:1073866687
Name:CHATHAM CARE PC
Entity Type:Organization
Organization Name:CHATHAM CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVIED
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-644-3461
Mailing Address - Street 1:907 N EAST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3425
Mailing Address - Country:US
Mailing Address - Phone:317-644-3461
Mailing Address - Fax:317-602-2654
Practice Address - Street 1:907 N EAST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3425
Practice Address - Country:US
Practice Address - Phone:317-644-3461
Practice Address - Fax:317-602-2654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty