Healthcare Provider Details

I. General information

NPI: 1861570053
Provider Name (Legal Business Name): CHADWICK LOUIS SCOTT STFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 EASTWIND DR
WESTERVILLE OH
43081-3376
US

IV. Provider business mailing address

PO BOX 710793
COLUMBUS OH
43271-0793
US

V. Phone/Fax

Practice location:
  • Phone: 614-268-9561
  • Fax: 614-268-7849
Mailing address:
  • Phone: 614-268-9561
  • Fax: 614-268-7849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: