Provider Demographics
NPI:1023654258
Name:CHAD M KENNEDY MD PA
Entity type:Organization
Organization Name:CHAD M KENNEDY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-355-1700
Mailing Address - Street 1:1600 S COULTER ST STE B
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-0703
Mailing Address - Country:US
Mailing Address - Phone:806-355-1700
Mailing Address - Fax:
Practice Address - Street 1:1900 S COULTER ST STE P
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1795
Practice Address - Country:US
Practice Address - Phone:806-355-1700
Practice Address - Fax:806-355-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty