Provider Demographics
NPI:1750724175
Name:PAMELA J CHESSER
Entity type:Organization
Organization Name:PAMELA J CHESSER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, FITTER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:CHESSER
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:270-898-1819
Mailing Address - Street 1:180 TYREE RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-9408
Mailing Address - Country:US
Mailing Address - Phone:270-898-1819
Mailing Address - Fax:270-898-2442
Practice Address - Street 1:180 TYREE RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-9408
Practice Address - Country:US
Practice Address - Phone:270-898-1819
Practice Address - Fax:270-898-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6846310001Medicare NSC