Jose D Chavez Md Pa | |
17 Surrey Ct Columbia SC 29212-3139 | |
(803) 772-4172 | |
Not Available |
Full Name | Jose D Chavez Md Pa |
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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 |
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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 |
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Provider Enumeration Date | 01/30/2008 |
Last Update Date | 10/28/2008 |
Medicare PECOS PAC ID | 9335389402 |
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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 |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1194779900 PECOS PAC ID: 4789824855 Enrollment ID: I20130712000714 |
Northlake Family Medical Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3000 Ne Medical Park, Ste 101, Columbia, SC 29223 Phone: 803-419-5131 Fax: 803-419-5130 | |
Lagniappe Medical Clinics, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 74 Polo Rd, Columbia, SC 29223 Phone: 803-419-7780 Fax: 803-419-7781 | |