Provider Demographics
NPI:1396830543
Name:CHADWICK T CAUDILL MD PS
Entity Type:Organization
Organization Name:CHADWICK T CAUDILL MD PS
Other - Org Name:SOUTHWEST WOMEN'S HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHADWICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:CAUDILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-543-5980
Mailing Address - Street 1:10004 KENNERLY RD
Mailing Address - Street 2:SUITE 350A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2141
Mailing Address - Country:US
Mailing Address - Phone:314-543-5980
Mailing Address - Fax:
Practice Address - Street 1:10004 KENNERLY RD
Practice Address - Street 2:SUITE 350A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2141
Practice Address - Country:US
Practice Address - Phone:314-543-5980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108544207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H04268Medicare UPIN