Healthcare Provider Details

I. General information

NPI: 1629301163
Provider Name (Legal Business Name): CHAS PHYSICIAN SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 E BROADWAY
COLUMBIA MO
65201-8023
US

IV. Provider business mailing address

1605 E BROADWAY STE 300
COLUMBIA MO
65201-8023
US

V. Phone/Fax

Practice location:
  • Phone: 573-256-7700
  • Fax: 573-256-3003
Mailing address:
  • Phone: 573-256-7700
  • Fax: 573-256-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number36120
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: BARRY CHAMBERS
Title or Position: PRESIDENT
Credential:
Phone: 573-815-3072