Provider Demographics
NPI:1780802108
Name:ANDREW Y. CHAO, INC
Entity type:Organization
Organization Name:ANDREW Y. CHAO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE SUPERVISER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAILING
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-227-1511
Mailing Address - Street 1:683 BIG BEND RD
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-7723
Mailing Address - Country:US
Mailing Address - Phone:636-227-1511
Mailing Address - Fax:636-227-2452
Practice Address - Street 1:683 BIG BEND RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-7723
Practice Address - Country:US
Practice Address - Phone:636-227-1511
Practice Address - Fax:636-227-2452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2A51207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOB18404Medicare UPIN