| Angela Dean Chisholm, CNM | |
|
161 Alpine Dr, Shelbyville, KY 40065-8878 | |
| (502) 317-6211 | |
| (800) 887-3154 |
| Full Name | Angela Dean Chisholm |
|---|---|
| Gender | Female |
| Speciality | Advanced Practice Midwife |
| Location | 161 Alpine Dr, Shelbyville, Kentucky |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457581837 | NPI | - | NPPES |
| 7100711960 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367A00000X | Advanced Practice Midwife | 200950093NP (Oregon) | Secondary |
| 367A00000X | Advanced Practice Midwife | 3015481 (Kentucky) | Primary |
| Entity Name | Mid-valley Healthcare Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1689625980 PECOS PAC ID: 2769391523 Enrollment ID: O20031111000297 |
| Entity Name | Good Samaritan Hospital Corvallis |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1962453134 PECOS PAC ID: 1557270725 Enrollment ID: O20031125000163 |
| Entity Name | Samaritan Pacific Health Services Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1174888010 PECOS PAC ID: 2466353529 Enrollment ID: O20040204000304 |
| Entity Name | Mid-valley Healthcare Inc |
|---|---|
| Entity Type | Part A Provider - Critical Access Hospital |
| Entity Identifiers | NPI Number: 1689625980 PECOS PAC ID: 2769391523 Enrollment ID: O20061104000140 |
| Entity Name | Samaritan Pacific Health Services Inc |
|---|---|
| Entity Type | Part A Provider - Critical Access Hospital |
| Entity Identifiers | NPI Number: 1801847066 PECOS PAC ID: 2466353529 Enrollment ID: O20061104000163 |
| Mailing Address | Practice Location Address |
|---|---|
| Angela Dean Chisholm, CNM 524 1st St, Shelbyville, KY 40065-1051 Ph: (541) 602-7935 | Angela Dean Chisholm, CNM 161 Alpine Dr, Shelbyville, KY 40065-8878 Ph: (502) 317-6211 |