Provider Demographics
NPI:1689941635
Name:STEVEN C CHANDLER MD PC
Entity Type:Organization
Organization Name:STEVEN C CHANDLER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:CECIL
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-350-0920
Mailing Address - Street 1:1350 14TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4364
Mailing Address - Country:US
Mailing Address - Phone:256-318-2101
Mailing Address - Fax:
Practice Address - Street 1:1205 MEDICAL DR SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4330
Practice Address - Country:US
Practice Address - Phone:256-350-0920
Practice Address - Fax:256-355-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000079434Medicaid
AL51079434OtherBLUE CROSS AND BLUE SHIELD OF ALABAMA
AL110236864OtherRAILROAD MEDICARE
AL000079434Medicaid
AL000079434Medicare PIN