Provider Demographics
NPI:1235314659
Name:CHISM GROUP, INC
Entity Type:Organization
Organization Name:CHISM GROUP, INC
Other - Org Name:DIRECT MEDICAL INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-544-3361
Mailing Address - Street 1:404 E FANNIN AVE
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:TX
Mailing Address - Zip Code:75835-2134
Mailing Address - Country:US
Mailing Address - Phone:936-544-3361
Mailing Address - Fax:936-544-5443
Practice Address - Street 1:404 E FANNIN AVE
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-2134
Practice Address - Country:US
Practice Address - Phone:936-544-3361
Practice Address - Fax:936-544-5443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX0061290332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX531135OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX087396001Medicaid
TX016140801Medicaid