MEDICARE: CH ACO SERVICES OR LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1467343012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CH ACO SERVICES OR LLC

Provider Business Mailing Address
First Line	:	5750 JOHNSTON ST STE 205
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-5345
Country	:	US
Telephone Number	:	337-991-9276
Fax Number	:	337-991-9288

Provider Business Practice Location Address
First Line	:	5750 JOHNSTON ST STE 205
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-5345
Country	:	US
Telephone Number	:	337-991-9276
Fax Number	:

Authorized Official
Title or Position	:	SR. VP ADMINISTRATIVE SERVICES
Name	:	NICOLE HOWARD
Credential	:
Telephone Number	:	337-991-9276

Provider Enumeration Date	:	07/11/2025
Last Update Date	:	07/11/2025

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