Provider Demographics
NPI:1831261601
Name:CHANDS' MEDICAL OFFICE OF FREDERICKTOWN LLC
Entity type:Organization
Organization Name:CHANDS' MEDICAL OFFICE OF FREDERICKTOWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:GUPTA
Authorized Official - Last Name:CHAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-783-2320
Mailing Address - Street 1:101 N CHAMBER DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-7944
Mailing Address - Country:US
Mailing Address - Phone:573-783-2320
Mailing Address - Fax:573-783-4494
Practice Address - Street 1:101 N CHAMBER DR
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-7944
Practice Address - Country:US
Practice Address - Phone:573-783-2320
Practice Address - Fax:573-783-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG11633Medicare UPIN
MOG34221Medicare UPIN
MO263902Medicare ID - Type UnspecifiedRIVERBEND GBA