Provider Demographics
NPI:1821426685
Name:CAUDILL, CHADRICK SCOTT
Entity Type:Individual
Prefix:
First Name:CHADRICK
Middle Name:SCOTT
Last Name:CAUDILL
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:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:ISOM
Mailing Address - State:KY
Mailing Address - Zip Code:41824-0606
Mailing Address - Country:US
Mailing Address - Phone:606-476-9874
Mailing Address - Fax:606-476-9871
Practice Address - Street 1:1550 HIGHWAY 15 SOUTH
Practice Address - Street 2:
Practice Address - City:JEFF
Practice Address - State:KY
Practice Address - Zip Code:41751
Practice Address - Country:US
Practice Address - Phone:606-476-9874
Practice Address - Fax:606-476-9871
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1457631483Medicaid