MEDICARE: HENRY H. CHONG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	01070533A	IN
2	207RC0000X	Cardiovascular Disease Physician	35-07-0257	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000000752990	OTHER	ANTHEM, REID HOSPITAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073515276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY H. CHONG M.D.

Provider Business Mailing Address
First Line	:	1100 REID PKWY
Second Line	:	MEDICAL STAFF SERVICES
City	:	RICHMOND
State	:	IN
Zip	:	47374-1157
Country	:	US
Telephone Number	:	937-316-6350
Fax Number	:	937-316-6374

Provider Business Practice Location Address
First Line	:	1101 JACKSON STREET
Second Line	:	STE B
City	:	GREENVILLE
State	:	OH
Zip	:	45331-1183
Country	:	US
Telephone Number	:	937-316-6350
Fax Number	:	937-316-6374

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	05/12/2021

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Directions to “ HENRY H. CHONG M.D.” Practice Location

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