Provider Demographics
NPI:1952494718
Name:ALTMYER, CHAD S (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:S
Last Name:ALTMYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 S GLOSTER ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6546
Mailing Address - Country:US
Mailing Address - Phone:662-767-4200
Mailing Address - Fax:662-767-4201
Practice Address - Street 1:1211 S GLOSTER ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6546
Practice Address - Country:US
Practice Address - Phone:662-767-4200
Practice Address - Fax:662-767-4201
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16802207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09259057Medicaid
MS0541610001Medicare NSC
MSH90760Medicare UPIN
MS09259057Medicaid