=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063658383
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHAD O. PATTERSON MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2008
-----------------------------------------------------
Last Update Date | 12/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 OXFORD WAY STE A
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42503-2813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-679-5161
-----------------------------------------------------
Fax | 606-679-9308
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 OXFORD WAY STE A
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42503-2813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-679-5161
-----------------------------------------------------
Fax | 606-679-9308
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL SURGEON
-----------------------------------------------------
Name | CHAD O PATTERSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 606-679-5161
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 41195
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------