Provider Demographics
NPI:1326312976
Name:CHAS PHYSICIAN SERVICES, LLC
Entity Type:Organization
Organization Name:CHAS PHYSICIAN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-815-3210
Mailing Address - Street 1:1600 E BROADWAY
Mailing Address - Street 2:BOX 6
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-5844
Mailing Address - Country:US
Mailing Address - Phone:573-815-7119
Mailing Address - Fax:
Practice Address - Street 1:1605 E BROADWAY
Practice Address - Street 2:SUITE 110
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8023
Practice Address - Country:US
Practice Address - Phone:573-815-7119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA2108Medicare PIN