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NPI Code Detail

MEDICARE: CHAD MICHAEL MOODY PA-C

MEDICARE: CHAD MICHAEL MOODY PA-C
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
1363A00000XPhysician AssistantPA04719TX
2363AM0700XMedical Physician AssistantPA04719TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11070770OTHERTXPA NATIONAL CERTIFICATION
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487617890
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHAD MICHAEL MOODY PA-C
Provider Business Mailing Address
First Line : 2421 WORTH ST
Second Line :
City : HEMPHILL
State : TX
Zip : 75948-7215
Country : US
Telephone Number : 409-787-1416
Fax Number : 409-787-1419
Provider Business Practice Location Address
First Line : 2421 WORTH ST
Second Line :
City : HEMPHILL
State : TX
Zip : 75948-7215
Country : US
Telephone Number : 409-787-1416
Fax Number : 409-787-1419
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2006
Last Update Date : 03/07/2022

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Directions to “ CHAD MICHAEL MOODY PA-C” Practice Location

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