Provider Demographics
NPI:1861446676
Name:COUCH, CHAD T (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:T
Last Name:COUCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:350 BLOUNTVILLE HWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-0213
Mailing Address - Country:US
Mailing Address - Phone:423-844-6600
Mailing Address - Fax:423-968-1255
Practice Address - Street 1:350 BLOUNTVILLE HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-0213
Practice Address - Country:US
Practice Address - Phone:423-844-6600
Practice Address - Fax:423-968-1255
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN034328208800000X
TN34328208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3150974OtherBLUECROSS BLUESHIELD
VA381841OtherANTHEM
0213340004OtherDMERC
340017986OtherRR MEDICARE
TN3854657Medicaid
VA007503849Medicaid
62086999805OtherJOHN DEERE
E61347Medicare UPIN
3854657Medicare PIN