MEDICARE: JAMES H.T CHILLCOTT MD

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	207Q00000X	Family Medicine Physician	35063483	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134187107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES H.T CHILLCOTT MD

Provider Business Mailing Address
First Line	:	2422 LAKE AVE
Second Line	:
City	:	ASHTABULA
State	:	OH
Zip	:	44004-4985
Country	:	US
Telephone Number	:	440-992-4422
Fax Number	:	440-997-6507

Provider Business Practice Location Address
First Line	:	6441 S MAIN ST
Second Line	:
City	:	N KINGSVILLE
State	:	OH
Zip	:	44048
Country	:	US
Telephone Number	:	440-224-2255
Fax Number	:	440-997-6507

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	10/26/2012

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