Healthcare Provider Details

I. General information

NPI: 1801811542
Provider Name (Legal Business Name): CHADWARD THACKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 ADAMS LN STE 600-700
PIKEVILLE KY
41501-3087
US

IV. Provider business mailing address

PO BOX 1228
PIKEVILLE KY
41502-1228
US

V. Phone/Fax

Practice location:
  • Phone: 606-509-2000
  • Fax: 606-509-2002
Mailing address:
  • Phone: 606-509-2000
  • Fax: 606-509-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38711
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: