Provider Demographics
NPI:1336238591
Name:CHATHAM FACIAL PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:CHATHAM FACIAL PLASTIC SURGERY LLC
Other - Org Name:DR. DONN R. CHATHAM
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAYTH
Authorized Official - Middle Name:
Authorized Official - Last Name:BREEDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-945-3223
Mailing Address - Street 1:1919 STATE ST
Mailing Address - Street 2:SUITE 144
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4929
Mailing Address - Country:US
Mailing Address - Phone:812-945-3223
Mailing Address - Fax:
Practice Address - Street 1:1919 STATE STREET
Practice Address - Street 2:SUITE 144
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150
Practice Address - Country:US
Practice Address - Phone:812-945-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034016207YS0123X, 207YX0007X
KY23772207YS0123X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64237720Medicaid
IN100116140AMedicaid
KYP00180026OtherRAILROAD MEDICARE PIN
1629134739OtherNPI DR. DONN R. CHATHAM
KYDC6172OtherRAILROAD MEDICARE GROUP
INDB7559OtherRAILROAD MEDICARE GROUP
INP00125999OtherRAILROAD MEDICARE PIN
000000323054OtherANTHEM BCBS
IN100116140AMedicaid
IN216610AMedicare PIN
000000323054OtherANTHEM BCBS
C75291Medicare UPIN
KY64237720Medicaid