Provider Demographics
NPI:1659195345
Name:CHESTNUT HEALTH OF MISSOURI LLC
Entity type:Organization
Organization Name:CHESTNUT HEALTH OF MISSOURI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAI
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-348-6060
Mailing Address - Street 1:1530 N RANDALL RD STE 210
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-7879
Mailing Address - Country:US
Mailing Address - Phone:703-348-6060
Mailing Address - Fax:703-649-6188
Practice Address - Street 1:13700 OLD HALLS FERRY RD
Practice Address - Street 2:
Practice Address - City:BLACK JACK
Practice Address - State:MO
Practice Address - Zip Code:63033-4109
Practice Address - Country:US
Practice Address - Phone:314-355-0760
Practice Address - Fax:703-649-6188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty