| Jose D Chavez MD PA | |
|
17 Surrey Ct Columbia SC 29212-3139 | |
| (803) 772-4172 | |
| Not Available |
| Full Name | Jose D Chavez MD PA |
|---|---|
| Speciality | Family Medicine |
| Location | 17 Surrey Ct, Columbia, South Carolina |
| Authorized Official Name and Position | Lenore Chavez (OFFICE MANAGER) |
| Authorized Official Contact | 8037724172 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jose D Chavez MD PA 17 Surrey Ct Columbia SC 29212-3139 Ph: (803) 772-4172 | Jose D Chavez MD PA 17 Surrey Ct Columbia SC 29212-3139 Ph: (803) 772-4172 |
| NPI Number | 1720265952 |
|---|---|
| Provider Enumeration Date | 01/30/2008 |
| Last Update Date | 10/28/2008 |
| Medicare PECOS PAC ID | 9335389402 |
|---|---|
| Medicare Enrollment ID | O20130712000690 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720265952 | NPI | - | NPPES |
| 086365 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 8636 (South Carolina) | Primary |
| Provider Name | Jose D Chavez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1194779900 PECOS PAC ID: 4789824855 Enrollment ID: I20130712000714 |
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