Healthcare Provider Details

I. General information

NPI: 1720176498
Provider Name (Legal Business Name): BERT CHRONISTER, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 MAIN ST
NEODESHA KS
66757-1673
US

IV. Provider business mailing address

806 MAIN ST P.O. BOX 118
NEODESHA KS
66757-1673
US

V. Phone/Fax

Practice location:
  • Phone: 620-325-2622
  • Fax: 620-325-5380
Mailing address:
  • Phone: 620-325-2622
  • Fax: 620-325-5380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number13253
License Number StateKS

VIII. Authorized Official

Name: DR. BERT CHRONISTER
Title or Position: OWNER
Credential: M.D.
Phone: 620-325-2622