Provider Demographics
NPI:1467113910
Name:PRICE, CHAD
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:
Last Name:PRICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 E MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-4309
Mailing Address - Country:US
Mailing Address - Phone:863-800-3196
Mailing Address - Fax:
Practice Address - Street 1:710 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-4309
Practice Address - Country:US
Practice Address - Phone:863-800-3196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory